AIM:To compare the surgical outcomes of glaucoma drainage device implantation(GDI)and trans-scleral neodymium:YAG cyclophotocoagulation(CPC)in the management of refractory glaucoma after Descemetstripping automated en...AIM:To compare the surgical outcomes of glaucoma drainage device implantation(GDI)and trans-scleral neodymium:YAG cyclophotocoagulation(CPC)in the management of refractory glaucoma after Descemetstripping automated endothelial keratoplasty(DSAEK).METHODS:This retrospective study on observational case series enrolled 29 patients who underwent DSAEK and posterior anti-glaucoma surgery(15 with GDI and 14 with CPC).The main outcome measures were intraocular pressure(IOP),glaucoma surgery success rate(defined as IOP of 6–21 mm Hg without additional anti-glaucoma operation),number of glaucoma medications,endothelial graft status,and best-corrected visual acuity(BCVA).RESULTS:The mean follow-up time was 34.1 and 21.0mo for DSAEK or glaucoma surgeries,both for the GDI and CPC groups.Both groups showed significant IOP reduction after glaucoma surgery.The GDI group presented a significantly higher success rate in IOP control than the CPC group(60%vs 21.4%,P=0.03).Both procedures significantly decreased the number of glaucoma medications(P=0.03).Forty percent and 57%of cases in the GDI and the CPC group,respectively,experienced endothelial graft failure during follow-up(P=0.36).Significantly worse BCVA after surgery was observed in the CPC group but not in the GDI group.CONCLUSION:Both GDI and CPC significantly decrease IOP in eyes with glaucoma after DSAEK.GDI is preferable to CPC in refractory glaucoma cases after DSAEK,as it manifests a significantly higher success rate for IOP control,similar endothelial graft failure rate,and relatively preserves BCVA than CPC.展开更多
AIM:To report the indications for and techniques of corneal transplantation at Vietnam National Institute of Ophthalmology(VNIO) over a period of 12y(2002-2013).· METHODS:Records of patients who had undergone cor...AIM:To report the indications for and techniques of corneal transplantation at Vietnam National Institute of Ophthalmology(VNIO) over a period of 12y(2002-2013).· METHODS:Records of patients who had undergone corneal transplantation at VNIO from January 1,2002 to January 1,2014 were reviewed to determine the indication for and type of corneal transplant performed.Patient age,gender,indication for corneal transplantation and surgical technique were recorded and analyzed.· RESULTS:Corneal transplantation were underwent in1390 eyes of 1278 patients with a mean age of 44.9±18.1y during the period under review.The most common indication was infectious corneal ulcer(n =670;48.2%),followed by corneal scar(n =333,24.0%),corneal dystrophy(n=138,9.9%) and failed graft(n=112,8.1%).Nearly all procedures performed were penetrating keratoplasty(n=1300,93.5%),with a few lamellar keratoplasty procedures performed:lamellar keratoplasty(n=52,3.7%),Descemet's stripping automated endothelial keratoplasty(n =27,1.9%) and deep anterior lamellar keratoplasty(n =11,0.8%).· CONCLUSION:While the most common indication for keratoplasty was infectious keratitis,nearly all indications for corneal transplantation were managed with penetrating keratoplasty.However,lamellar keratoplasty techniques,including deep anterior lamellar keratoplasty and Descemet's stripping automated endothelial keratoplasty,are being performed with increasing frequency for isolated stromal and endothelial disorders,respectively.展开更多
AIM:To report the outcomes of three cases of corneal perforation managed with simultaneous tectonic Descemet stripping endothelial keratoplasty(t-DSEK)and tectonic Bowman layer transplant(t-BLT)as an alternative to te...AIM:To report the outcomes of three cases of corneal perforation managed with simultaneous tectonic Descemet stripping endothelial keratoplasty(t-DSEK)and tectonic Bowman layer transplant(t-BLT)as an alternative to tectonic penetrating keratoplasty(t-PKP).METHODS:Three eyes of three patients receiving simultaneous t-DSEK and t-BLT for corneal perforation were included.The technique for DSEK was modified depending on individual requirements.The t-BLT technique was standardised using an 8 mm graft and fixated with a running suture.Success was measured by the ability of this procedure to close a corneal perforation.RESULTS:All three cases achieved tectonic eye globe restoration and remained stable during the minimum 3-month observation period.Reinterventions were relatively common:2 cases required amniotic membrane transplant for persistent epithelial defects.One case required DSEK rebubbling.One case developed angle closure glaucoma requiring surgical peripheral iridectomy.CONCLUSION:Simultaneous t-DSEK and t-BLT may be a useful strategy for the management of corneal perforation as an alternative management to t-PKP for selected cases.展开更多
Deep anterior lamellar keratoplasty(DALK) has recently been introduced as an alternative procedure to penetrating keratoplasty(PK) for corneal pathologies not affecting the corneal endothelium. DALK does not rely on d...Deep anterior lamellar keratoplasty(DALK) has recently been introduced as an alternative procedure to penetrating keratoplasty(PK) for corneal pathologies not affecting the corneal endothelium. DALK does not rely on donor endothelium and requires less rigid criteria for donor corneal tissue quality. Therefore, DALK makes it possible to use donor corneas deemed unsuitable for PK. Furthermore, lamellar keratoplasty allows acellular corneal tissue to be transplanted. As a result, long-term preservation techniques are being revisited to increase the availability of donor corneas and subsequently alleviate constraints of availability, cost, storage, and transportation in many countries. The recent alterations in corneal transplantation techniques and hence the type of donor cornea tissues used for each technique, may require corneal surgeons and eye banks to reevaluate their selection criteria. The purpose of this systematic review is to present an updated analysis on the type and quality of donor corneas used for PK and DALK, assess the influence of donor and eye bank factors on the quality of donor corneas, and determine whether any of these donor factors affect clinical outcomes, complications, and graft survivals.展开更多
AIM:To investigate whether the two-step strategy[conjunctival flap covering surgery(CFCS)combined with secondary deep anterior lamellar keratoplasty(DALK)]is effective for patients with high-risk fungal keratitis(FK)....AIM:To investigate whether the two-step strategy[conjunctival flap covering surgery(CFCS)combined with secondary deep anterior lamellar keratoplasty(DALK)]is effective for patients with high-risk fungal keratitis(FK).METHODS:In this noncomparative,retrospective case series,10 subjects(6 males,4 females)with a mean age of 56.5±7.1(range 47-72)y with high-risk FK undergone the two-step strategy were included.Reported outcome measures were healing of the corneal ulcer,recurrence of FK,reject reaction,improvement in best corrected visual acuity(BCVA)and relevant complications.RESULTS:The average diameter of corneal infiltrates was 7.50±0.39 mm,ranging from 6.94 to 8.13 mm.The mean depth of corneal infiltrates was 422.4±77.1μm,ranging from 350 to 535μm.The mean corneal thickness was 597.4±117.3μm,ranging from 458 to 851μm.Hypopyon and endothelial plaques were presented in all patients.The period between the two steps was 3.65±0.9(ranging from 3 to 5)mo.The graft diameter was 7.75±0.39 mm.At the last follow-up(average 9.25±3.39,ranging from 5.5 to 17mo),no fungal recurrence or graft rejection appeared,and all patients showed improvement of BCVA.One patient suffered from liver function impairment due to oral voriconazole for 4wk and recovered spontaneously after 1wk of drug withdrawal.CONCLUSION:The two-step strategy is safe and effective in the treatment of high-risk FK by transforming intentional therapeutic penetrating keratoplasty during acute infection to later optical DALK.It is a practical strategy,especially in areas lacking fresh donor corneas and eye bank services.展开更多
AIM:To investigate corneal graft survival rate and endothelial cell density(ECD)loss after keratoplasty in cytomegalovirus(CMV)positive patients.METHODS:This was a retrospective cohort study.We analyzed the clinical d...AIM:To investigate corneal graft survival rate and endothelial cell density(ECD)loss after keratoplasty in cytomegalovirus(CMV)positive patients.METHODS:This was a retrospective cohort study.We analyzed the clinical data of patients who underwent viral DNA detection in aqueous humor/corneal tissue collected during keratoplasty from March 2015 to December 2018 at the Peking University Third Hospital,Beijing,China.To further evaluate the effect of CMV on graft survival rate and ECD loss,patients were divided into three groups:1)CMV DNA positive(CMV+)group;2)viral DNA negative(virus-)group,comprising virus-group eyes pairwise matched to eyes in the CMV+group according to ocular comorbidities;3)control group,comprising virus-group eyes without ocular comorbidities.The follow-up indicators including graft survival rate,ECD,ECD loss,and central corneal thickness(CCT),were analyzed by Tukey honestly significant difference(HSD)test.RESULTS:Each group included 29 cases.The graft survival rate in CMV+group were lowest among the three groups(P=0.000).No significant difference in donor graft ECD was found among three groups(P=0.54).ECD in the CMV+group was lower than the virus-group at 12(P=0.009),and 24mo(P=0.002)after keratoplasties.Furthermore,ECD loss was higher in the CMV+group than in the virus-group in the middle stage(6-12mo)postkeratoplasty(P=0.017),and significantly higher in the early stage(0-6mo)in the virus-group than in the control group(P=0.000).CONCLUSION:CMV reduces the graft survival rate and exerts persistent detrimental effects on the ECD after keratoplasty.The graft ECD loss associate with CMV infection mainly occurrs in the middle stage(6-12mo postoperatively),while ocular comorbidities mainly affects ECD in the early stage(0-6mo postoperatively).展开更多
AIM: To determine the incidence of cystoid macular edema(CME) after Descemet's stripping automated endothelial keratoplasty(DSAEK).METHODS: This study included all consecutive patients operated in a Spanish tertia...AIM: To determine the incidence of cystoid macular edema(CME) after Descemet's stripping automated endothelial keratoplasty(DSAEK).METHODS: This study included all consecutive patients operated in a Spanish tertiary reference hospital over a period of four years. A total of 55 eyes from 47 patients matched the selection criteria. CME was diagnosed clinically at the slit-lamp and confirmed by optical coherence tomography. RESULTS: Six cases of CME were diagnosed postoperatively, which represented an incidence of 11%. Three patients had previously undergone DSAEK alone(7%; 3/41) and the other three, DSAEK combined with phacoemulsification(21%; 3/14). Five out of six patients with CME responded to standard therapy.CONCLUSION: CME is a possible complication after DSAEK and can be treated with standard therapy. CME appears more frequently when DSAEK is combined with phacoemulsification and posterior chamber(PC) intraocular lens(IOL) implantation. Intraoperative damage to the corneal endothelial cells might play a role in the pathogenesis of CME. As long as the causes remain unclear, we recommend administering prophylaxis when risk factors are present or when combined surgery is planned.展开更多
AIM:To compare visual,surgical and topographic outcomes of deep anterior lamellar keratoplasty(DALK)and penetrating keratoplasty(PK)for keratoconus(KC).METHODS:In this multicenter,prospective,randomized clinical trial...AIM:To compare visual,surgical and topographic outcomes of deep anterior lamellar keratoplasty(DALK)and penetrating keratoplasty(PK)for keratoconus(KC).METHODS:In this multicenter,prospective,randomized clinical trial 76 eyes of 71 KC patients operated between January 2011 and July 2014 in 2 tertiary referral hospitals were included. Consecutive patients were alternately selected to receive one of the two surgical methods. Thirty eight eyes underwent DALK with the big-bubble technique and 38 eyes underwent PK.RESULTS:Mean best spectacle corrected visual acuity(BSCVA)at the first postoperative week(P=0.012)and the first postoperative month(P<0.001)was statistically significantly higher in DALK group. The mean BSCVA at12 mo was not significantly different for DALK(0.30±1.99 log MAR)versus PK(0.40±0.33 log MAR)(P=0.104). The76.3% of the eyes had a BSCVA over 0.5 in DALK and 47.4%in PK group(P=0.009). The 7.9% of the eyes had a BSCVA of 1.0 in DALK and 5.3% in PK group(P=0.644). Mean spherical equivalent was-2.94 D in DALK and-3.09 D in PK group.Mean topographic astigmatism was 4.62 D and 4.18 D respectively. Regular topographic patterns were observed in 31(81.6%)of DALK and 29(76.3%)of PK(P=0.574). The most frequent topographic pattern was oblate asymmetric bow tie,seen in 39.5% in DALK and 23.7% in PK. CONCLUSION:Big bubble DALK provides an earlier visual improvement compare to PK. However,visual and topographic outcomes are similar to those in PK at 1y. Postoperative complications including rejection and intraocular pressure elevation are more frequent in PK. DALK is a safer alternative to PK for KC. However,intraoperativeperforation of the Descemet's membrane is a significant complication.展开更多
AIM: To evaluate the efficacy of a technical modification to reduce the incidence of traumatic cataract induced by Descemet stripping automated endothelial keratoplasty(DSAEK) performed in phakic eyes. METHODS: A retr...AIM: To evaluate the efficacy of a technical modification to reduce the incidence of traumatic cataract induced by Descemet stripping automated endothelial keratoplasty(DSAEK) performed in phakic eyes. METHODS: A retrospective cohort study. The records of all patients with a clear crystalline lens and endothelial failure that underwent modified DSAEK at our insitution were reviewed. In this modification, in order to avoid inadvertent touch of the insertion forceps against the exposed crystalline lens while passing across the anterior chamber, the incision sites were shifted from the standard 9 and 3 o'clock positions, superiorly to the 10 and 2 o'clock position respectively. Formation of typically traumatic, anterior subcapsular cataract in these patients was compared to that observed in a cohort including all the patients with a clear crystalline lens and endothelial failure that underwent conventional DSAEK at our institution.RESULTS: The study group included 49 eyes following modified DSAEK and the control group included 35 eyes following DSAEK with conventional incision sites. Anterior subcapsular cataract occurring 4 mo or less postoperatively was identified in 2 of 49(4%) eyes in the study group and 7 of 35(20%) eyes in the control group. The rates of traumatic cataract were significantly higher in the control group in comparison to the study group(P=0.03, RR=4.9, 95%CI 1.08-22.1).CONCLUSION: Traumatic cataract formation following phakic DSAEK may be avoided with a simple modification to the position of the incision sites.展开更多
AIM: To investigate the impact of non-Descemet stripping endothelial keratoplasty(non-DSEK) on graft rejection rate,and its overall procedural effectiveness in patients.METHODS: Non-DSEK was performed on 65 eyes of 64...AIM: To investigate the impact of non-Descemet stripping endothelial keratoplasty(non-DSEK) on graft rejection rate,and its overall procedural effectiveness in patients.METHODS: Non-DSEK was performed on 65 eyes of 64 patients,and the procedural outcomes,including rejection episodes,failure and dislocation of the grafts,best corrected visual acuity(BCVA),endothelial cell density(ECD),and other complications,were analyzed retrospectively.RESULTS: Of the 65 eyes,63 recovered from bullous keratopathy with a clear cornea.The mean follow-up time was 26.4mo(range,6-84mo).The mean BCVA improved from 1.70 log MAR preoperatively to 0.54 log MAR at 3mo,0.46 logM AR at 6mo,and 0.37 logM AR at 1y after surgery.The postoperative donor ECD of the 25 patients who successfully underwent specular microscopic examination was 1918±534 cells/mm^2(range,637 to 3056 cells/mm^2),and the mean endothelial cell loss was 41.9% at 24 mo postoperatively.One eye developed secondary glaucoma and required regrafting via penetrating keratoplasty(PKP).Another eye had postoperative graft failure due to rejection at 26 mo.Postoperative graft dislocation occurred in eight eyes.All of the eight dislocated grafts were reattached using air reinjection.CONCLUSION: Immunological graft rejection of the donor graft rarely occurs in non-DSEK.Therefore,non-DSEK is a safe,concise,and effective alternative to restore corneal decompensation when the Descemet membrane is disease-free.展开更多
AIM: To review the indications of penetrating keratoplasty(PK) and anterior lamellar keratoplasty(ALK) at Qingdao Eye Hospital, Shandong Eye Institute, Qingdao, China, from 2010 to 2017. METHODS: The data of all patie...AIM: To review the indications of penetrating keratoplasty(PK) and anterior lamellar keratoplasty(ALK) at Qingdao Eye Hospital, Shandong Eye Institute, Qingdao, China, from 2010 to 2017. METHODS: The data of all patients undergoing PK or ALK from January 2010 to December 2017 was retrospectively reviewed, with the indications during 2010-2013 and 2014-2017 compared. RESULTS: A total of 1869 eyes were included, among which 1405 eyes(75.2%) had PK and 464 eyes(24.8%) had ALK. The leading indications were suppurative keratitis(36.8%), keratoconus(15.5%), herpes keratitis(13.1%), and regraft(10.5%). In eyes undergoing PK, the top four indications were suppurative keratitis(38.7%), herpes keratitis(15.3%), keratoconus(12.6%), and regraft(12.5%) during 2014-2017, with the proportion of suppurative keratitis and herpes keratitis decreased while regraft and keratoconus increased compared with 2010-2013. In eyes with ALK, suppurative keratitis(30.8%), keratoconus(24.1%), corneal dystrophies and degenerations(10.6%), and corneal dermoid tumor(9.7%) were the top four indications, and there was no significant difference for the proportion of each indication between 2010-2013 and 2014-2017. CONCLUSION: Suppurative keratitis is the most common indication for PK and ALK at Qingdao Eye Hospital during 2010-2017, followed by keratoconus, herpes keratitis, and regraft. In eyes treated with PK, the proportion of suppurative keratitis and herpes keratitis decrease while regraft and keratoconus increase during 2014-2017 compared with 2010-2013.展开更多
To assess the postoperative outcomes of limbal dermoid excision with corneoscleral graft transplantation. The charts of 8 consecutive patients(mean age: 13.0 y) who had undergone limbal dermoid excision with lamellar ...To assess the postoperative outcomes of limbal dermoid excision with corneoscleral graft transplantation. The charts of 8 consecutive patients(mean age: 13.0 y) who had undergone limbal dermoid excision with lamellar corneoscleral graft transplantation by a single surgeon were retrospectively reviewed. Mean dermoid size was 7.75 mm(6.0-12.0 mm). Mean visual acuities(in log MAR units) before and after surgery were 1.8 and 1.7, respectively(P=0.29). Spherical equivalents were 1.3 diopter(D) before surgery and 0.7 D after surgery(P=0.40). The mean astigmatism measurements before and after surgery were 2.4 D and 1.5 D, respectively(P=0.17). Vector analysis revealed a mild change in astigmatism with a mean "d" of 3.2(0.56-6.89). No intra-or post-operative complications occurred. Lamellar keratoplasty for limbal dermoids is safe and offers good cosmesis and tectonic stability. A significant decrease in the amount of astigmatism is not expected following surgery.展开更多
Purpose: To develop a new method of femtosecond laser-assisted refractive autokeratoplasty (FRAK) in advanced keratoconus and to evaluate preliminarily early clinical results. Methods: A total of 17 patients with stab...Purpose: To develop a new method of femtosecond laser-assisted refractive autokeratoplasty (FRAK) in advanced keratoconus and to evaluate preliminarily early clinical results. Methods: A total of 17 patients with stable advanced keratoconus and a mean age of 33 ± 8.4 years were included in the study. FRAK was performed in all cases with the IntraLase 60 kHz (Abbott Medical Optics Inc.). A 2-step resection of corneal stroma was performed using the femtosecond laser, with the generation of a circular corneal flap with wedge-shaped profile. After flap removal, the corneal wound was sutured. Results: The surgical procedure and early postoperative period were uneventful in all cases. Mean uncorrected distance visual acuity (UDVA) improved significantly from 0.07 ± 0.03 preoperatively to 0.26 ± 0.13 at 3 months after surgery. Improvement in corrected distance visual acuity (CDVA) was observed in 94.1% of cases, with 76.5% of eyes showing an improvement of more than 3 lines. Between 3 and 6 months after surgery, an additional improvement was observed in UDVA and CDVA. Corneal cylinder decreased significantly from 9.1 ± 3.8 D preoperatively to 4.4 ± 2.75 D at 6 months postoperatively. Conclusions: FRAK may be an alternative treatment in stable advanced keratoconus, allowing a significant visual improvement and corneal regularization while saving the patient's own corneal tissue. The non-penetrating nature of the surgical technique helps to minimize the risks associated to this type of surgery. Further research is needed to determine the functional long-term outcomes.展开更多
AIM: To evaluate the effect of corneal graft diameter on therapeutic penetrating keratoplasty(PKP) for fungal keratitis. METHODS: A total of 116 patients (116 eyes) suffered from fungal keratitis underwent PKP at the ...AIM: To evaluate the effect of corneal graft diameter on therapeutic penetrating keratoplasty(PKP) for fungal keratitis. METHODS: A total of 116 patients (116 eyes) suffered from fungal keratitis underwent PKP at the Affiliated Hospital of Medical College Qingdao University from May 2006 to May 2010. They were divided into two groups according to the corneal graft diameter. 64 eyes' corneal graft diameter was 8.00mm or larger and 52 eyes' graft diameter was smaller than 8.00mm. The follow-up time was 2 years. The postoperative visual acuity and complications were documented and compared. RESULTS: Sixty-two (96.88%) eyes and fifty (96.15%) eyes preserved eyeballs respectively in two groups. There was no statistical difference in postoperative visual acuity (P =0.961), corneal graft clear rate (P =0.132) or the incidence of recurred fungal infection (P =0.770) between two groups. But there was a higher incidence of graft rejection (P =0.020) and secondary glaucoma (P =0.039) in group with corneal graft diameter 8.00mm or larger. CONCLUSION: PKP is an effective treatment approach for fungal keratitis. There is a higher incidence of complications in large-diameter PKP for fungal keratitis.Effective, preventive and therapeutic measures can improve the prognosis.展开更多
AIM:To identify the current indications and the trend shifts for penetrating keratoplasty(PKP) in Shandong.METHODS:The medical charts of all patients who underwent PKP at Shandong Eye Institute from June 1,2005 to May...AIM:To identify the current indications and the trend shifts for penetrating keratoplasty(PKP) in Shandong.METHODS:The medical charts of all patients who underwent PKP at Shandong Eye Institute from June 1,2005 to May 31,2010 were analysed retrospectively.RESULTS:A total of 875 patients(875 eyes) received PKP in this 5-year period,accounting for 61.6% of all corneal transplantation surgeries.The leading indications for PKP were infectious keratitis(37.1%),HSK(19.1%),keratoconus(11.2%),bullous keratopathy(8.5%),regrafting(6.7%) and corneal scarring(4.8%).The percentage of PKP for keratoconus declined year by year,whereas the percentage of bullous keratopathy had a mild annual increase.Fungal infections accounted for 65.2% of the infectious keratitis cases,remaining the leading cause of corneal infection.In addition,54.1% of bullous keratopathy cases were associated with cataract surgery.The leading initial diagnoses associated with regrafting were infectious keratitis(38.9%),HSK(18.6%) and corneal burn(16.9%).The major causes of regrafting included graft endothelial dysfunction(39.0%),graft ulcer(28.8%) and primary disease recurrence(15.3%).CONCLUSION:Infectious keratitis remained the leading indication for PKP in Shandong,and fungal infections were still the major cause of corneal infections.There was an increasing trend in the percentage of PKP cases indicated for bullous keratopathy but a decline in the same for keratoconus.Even with a decline in the overall proportion among all corneal transplantation surgeries,PKP is still the major corneal transplant choice in Shandong.展开更多
·AIM: To describe the initial outcomes and safety of femtosecond laser-assisted deep anterior lamellar keratoplasty(DALK) for keratoconus and post-LASIK keratectasia.·METHODS: In this non-comparative case se...·AIM: To describe the initial outcomes and safety of femtosecond laser-assisted deep anterior lamellar keratoplasty(DALK) for keratoconus and post-LASIK keratectasia.·METHODS: In this non-comparative case series, 10 eyes of 9 patients underwent DALK procedures with a femtosecond laser(Carl Zeiss Meditec AG, Jena,Germany). Of the 9 patients, 7 had keratoconus and 2had post-LASIK keratectasia. A 500 kHz VisuMax femtosecond laser was used to perform corneal cuts on both donor and recipient corneas. The outcome measures were the uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA), corneal thickness,astigmatism, endothelial density count(EDC), and corneal power.·RESULTS: All eyes were successfully treated. Early postoperative evaluation showed a clear graft in all cases. Intraoperative complications included one case of a small Descemet's membrane perforation.Postoperatively, there was one case of stromal rejection,one of loosened sutures, and one of wound dehiscence.A normal corneal pattern topography and transparency were restored, UCVA and BCVA improved significantly,and astigmatism improved slightly. There was no statistically significant decrease in EDC.· CONCLUSION: Our early results indicate that femtosecond laser-assisted deep anterior lamellar keratoplasty could improve UCVA and BCVA in patients with anterior corneal pathology. This approach shows promise as a safe and effective surgical choice in the treatment of keratoconus and post-LASIK keratectasia.展开更多
Dear Sir, I am Dr Yan-Long Bi, from the Department of Ophthalmology, Tongji University Affiliated to Tongji University School of Medicine, Shanghai, China. I write to present a case report of total limbal stem cells d...Dear Sir, I am Dr Yan-Long Bi, from the Department of Ophthalmology, Tongji University Affiliated to Tongji University School of Medicine, Shanghai, China. I write to present a case report of total limbal stem cells deficiency after treatment with ring-shaped lamellar keratoplasty secondary to Terrien marginal degeneration. During 3展开更多
AIM: To demonstrate the changes in ultrastructure and histopathology of the cornea in acute corneal alkaline burns after femtosecond laser-assisted deep lamellar keratoplasty.·METHODS: The New Zealand white rabbi...AIM: To demonstrate the changes in ultrastructure and histopathology of the cornea in acute corneal alkaline burns after femtosecond laser-assisted deep lamellar keratoplasty.·METHODS: The New Zealand white rabbits treated with alkaline corneal burn were randomized into two groups,Group A(16 eyes) with femtosecond laser-assisted deep lamellar keratoplasty 24 h after burn and Group B(16 eyes)without keratoplasty as controls. All eyes were evaluated with transmission electron microscopy(TEM) at 1, 2, 3,and 4wk follow-up, then all corneas were tested by hematoxylin and eosin staining histology.· RESULTS: The corneal grafts in Group A were transparent, while those in Group B showed corneal stromal edema and loosely arranged collagen fibers. One week after treatment, TEM revealed the intercellular desmosomes in the epithelial layers and intact non-dissolving nuclei in Group A. At week 4, the center of the corneas in Group A was transparent with regularly arranged collagen fibers and fibroblasts in the stroma. In Group B, squamous cells were observed on the corneal surface and some epithelial cells were detached.· CONCLUSION: Femtosecond laser-assisted deep lamellar keratoplasty can suppress inflammatory responses, prevent toxic substance-induced injury to the corneal endothelium and inner tissues with quicker recovery and better visual outcomes.展开更多
Twenty samples of endothelia removed from normal and post penetrating keratoplas-ty (0.5,1,2,3 months after penetrating keratoplasty) were observed by scanning electron mi-croscopy.The photographs of the endothelia in...Twenty samples of endothelia removed from normal and post penetrating keratoplas-ty (0.5,1,2,3 months after penetrating keratoplasty) were observed by scanning electron mi-croscopy.The photographs of the endothelia in graft-host junction were analyzed by computer-assisted image analysis system,and the morphometric indexes examined were area of the cells,perimeters,density,figure coefficient,long axis,coefficient of variation of the area,and oth-ers.Results showed that the morphology and the density of the endothelial cells changed obvi-ously after operation and improved slowly but progressively with time although at 3 monthspostoperatively some differences still existed.By using the new techniques,the experiment con-firmed and enriched the theories on the corneal endothelial wound-healing,revealing some ofthe new characters of the endothelial wound-healing following penetrating keratoplasty.展开更多
AIM:To investigate the long-term results of penetrating keratoplasty(PK)in patients with keratoconus(KC)and to evaluate factors that might influence the final visual outcome.METHODS:We retrospectively reviewed the dat...AIM:To investigate the long-term results of penetrating keratoplasty(PK)in patients with keratoconus(KC)and to evaluate factors that might influence the final visual outcome.METHODS:We retrospectively reviewed the data of all patients with clinical KC who had undergone PK by a single corneal surgeon in a single center from May 1980to December 2005.The age of the patients,preoperative best-corrected visual acuity(BCVA),corneal thickness,death to preservation time,and preservation to transplantation time were recorded.Additionally,postoperative complications such as graft rejection,development of glaucoma and specular microscopy were checked during the follow-up.RESULTS:Sixty-nineeyesfrom69patientswerefinally included.The follow-up period was 8.64±6.13y.Graft rejection occurred in 4 eyes of 69 cases(5.8%),and the time to graft rejection was 2.1±1.3y.A Kaplan-Meier survival analysis showed that the estimated cumulative probability of graft rejection at 6,13,and 17y after PK were 95.6%,90.0%,and 78.8%,respectively.When we evaluated factors that might influence final BCVA in eyes,no disparity donor-host trephine size(same graft size)as well as higher spherical equivalent,and average Kvalue were associated with higher final BCVA.(P=0.006,0.051,0.092,and 0.021 in eyes with follow-up<8y;P=0.068,0.065,and 0.030 in eyes with follow-up≥8y,respectively).CONCLUSION:The long-term results of PK in patients with KC were favorable with a high percentage of good BCVA.Less myopic change and low average K-reading,as well as a surgical technique using the same size donor-recipient button may provide better visual outcomes particularly in patients with KC.展开更多
文摘AIM:To compare the surgical outcomes of glaucoma drainage device implantation(GDI)and trans-scleral neodymium:YAG cyclophotocoagulation(CPC)in the management of refractory glaucoma after Descemetstripping automated endothelial keratoplasty(DSAEK).METHODS:This retrospective study on observational case series enrolled 29 patients who underwent DSAEK and posterior anti-glaucoma surgery(15 with GDI and 14 with CPC).The main outcome measures were intraocular pressure(IOP),glaucoma surgery success rate(defined as IOP of 6–21 mm Hg without additional anti-glaucoma operation),number of glaucoma medications,endothelial graft status,and best-corrected visual acuity(BCVA).RESULTS:The mean follow-up time was 34.1 and 21.0mo for DSAEK or glaucoma surgeries,both for the GDI and CPC groups.Both groups showed significant IOP reduction after glaucoma surgery.The GDI group presented a significantly higher success rate in IOP control than the CPC group(60%vs 21.4%,P=0.03).Both procedures significantly decreased the number of glaucoma medications(P=0.03).Forty percent and 57%of cases in the GDI and the CPC group,respectively,experienced endothelial graft failure during follow-up(P=0.36).Significantly worse BCVA after surgery was observed in the CPC group but not in the GDI group.CONCLUSION:Both GDI and CPC significantly decrease IOP in eyes with glaucoma after DSAEK.GDI is preferable to CPC in refractory glaucoma cases after DSAEK,as it manifests a significantly higher success rate for IOP control,similar endothelial graft failure rate,and relatively preserves BCVA than CPC.
文摘AIM:To report the indications for and techniques of corneal transplantation at Vietnam National Institute of Ophthalmology(VNIO) over a period of 12y(2002-2013).· METHODS:Records of patients who had undergone corneal transplantation at VNIO from January 1,2002 to January 1,2014 were reviewed to determine the indication for and type of corneal transplant performed.Patient age,gender,indication for corneal transplantation and surgical technique were recorded and analyzed.· RESULTS:Corneal transplantation were underwent in1390 eyes of 1278 patients with a mean age of 44.9±18.1y during the period under review.The most common indication was infectious corneal ulcer(n =670;48.2%),followed by corneal scar(n =333,24.0%),corneal dystrophy(n=138,9.9%) and failed graft(n=112,8.1%).Nearly all procedures performed were penetrating keratoplasty(n=1300,93.5%),with a few lamellar keratoplasty procedures performed:lamellar keratoplasty(n=52,3.7%),Descemet's stripping automated endothelial keratoplasty(n =27,1.9%) and deep anterior lamellar keratoplasty(n =11,0.8%).· CONCLUSION:While the most common indication for keratoplasty was infectious keratitis,nearly all indications for corneal transplantation were managed with penetrating keratoplasty.However,lamellar keratoplasty techniques,including deep anterior lamellar keratoplasty and Descemet's stripping automated endothelial keratoplasty,are being performed with increasing frequency for isolated stromal and endothelial disorders,respectively.
文摘AIM:To report the outcomes of three cases of corneal perforation managed with simultaneous tectonic Descemet stripping endothelial keratoplasty(t-DSEK)and tectonic Bowman layer transplant(t-BLT)as an alternative to tectonic penetrating keratoplasty(t-PKP).METHODS:Three eyes of three patients receiving simultaneous t-DSEK and t-BLT for corneal perforation were included.The technique for DSEK was modified depending on individual requirements.The t-BLT technique was standardised using an 8 mm graft and fixated with a running suture.Success was measured by the ability of this procedure to close a corneal perforation.RESULTS:All three cases achieved tectonic eye globe restoration and remained stable during the minimum 3-month observation period.Reinterventions were relatively common:2 cases required amniotic membrane transplant for persistent epithelial defects.One case required DSEK rebubbling.One case developed angle closure glaucoma requiring surgical peripheral iridectomy.CONCLUSION:Simultaneous t-DSEK and t-BLT may be a useful strategy for the management of corneal perforation as an alternative management to t-PKP for selected cases.
基金Supported by The Ophthalmic Research Center,Shahid Beheshti University of Medical Sciences,Tehran,Iran
文摘Deep anterior lamellar keratoplasty(DALK) has recently been introduced as an alternative procedure to penetrating keratoplasty(PK) for corneal pathologies not affecting the corneal endothelium. DALK does not rely on donor endothelium and requires less rigid criteria for donor corneal tissue quality. Therefore, DALK makes it possible to use donor corneas deemed unsuitable for PK. Furthermore, lamellar keratoplasty allows acellular corneal tissue to be transplanted. As a result, long-term preservation techniques are being revisited to increase the availability of donor corneas and subsequently alleviate constraints of availability, cost, storage, and transportation in many countries. The recent alterations in corneal transplantation techniques and hence the type of donor cornea tissues used for each technique, may require corneal surgeons and eye banks to reevaluate their selection criteria. The purpose of this systematic review is to present an updated analysis on the type and quality of donor corneas used for PK and DALK, assess the influence of donor and eye bank factors on the quality of donor corneas, and determine whether any of these donor factors affect clinical outcomes, complications, and graft survivals.
基金Supported by the National Natural Science Foundation of China(No.82171025No.82070934)+2 种基金the Fundamental Research Funds for the Central Universities(No.HUST:2019kfy XMBZ065)the Key Research and Development Program of Hubei Province(No.2021BCA146)the Clinical Research Foundation of Wuhan Union Hospital(No.2021xhlcyj03)。
文摘AIM:To investigate whether the two-step strategy[conjunctival flap covering surgery(CFCS)combined with secondary deep anterior lamellar keratoplasty(DALK)]is effective for patients with high-risk fungal keratitis(FK).METHODS:In this noncomparative,retrospective case series,10 subjects(6 males,4 females)with a mean age of 56.5±7.1(range 47-72)y with high-risk FK undergone the two-step strategy were included.Reported outcome measures were healing of the corneal ulcer,recurrence of FK,reject reaction,improvement in best corrected visual acuity(BCVA)and relevant complications.RESULTS:The average diameter of corneal infiltrates was 7.50±0.39 mm,ranging from 6.94 to 8.13 mm.The mean depth of corneal infiltrates was 422.4±77.1μm,ranging from 350 to 535μm.The mean corneal thickness was 597.4±117.3μm,ranging from 458 to 851μm.Hypopyon and endothelial plaques were presented in all patients.The period between the two steps was 3.65±0.9(ranging from 3 to 5)mo.The graft diameter was 7.75±0.39 mm.At the last follow-up(average 9.25±3.39,ranging from 5.5 to 17mo),no fungal recurrence or graft rejection appeared,and all patients showed improvement of BCVA.One patient suffered from liver function impairment due to oral voriconazole for 4wk and recovered spontaneously after 1wk of drug withdrawal.CONCLUSION:The two-step strategy is safe and effective in the treatment of high-risk FK by transforming intentional therapeutic penetrating keratoplasty during acute infection to later optical DALK.It is a practical strategy,especially in areas lacking fresh donor corneas and eye bank services.
基金Supported by the National Natural Science Foundation of China(No.81970768)。
文摘AIM:To investigate corneal graft survival rate and endothelial cell density(ECD)loss after keratoplasty in cytomegalovirus(CMV)positive patients.METHODS:This was a retrospective cohort study.We analyzed the clinical data of patients who underwent viral DNA detection in aqueous humor/corneal tissue collected during keratoplasty from March 2015 to December 2018 at the Peking University Third Hospital,Beijing,China.To further evaluate the effect of CMV on graft survival rate and ECD loss,patients were divided into three groups:1)CMV DNA positive(CMV+)group;2)viral DNA negative(virus-)group,comprising virus-group eyes pairwise matched to eyes in the CMV+group according to ocular comorbidities;3)control group,comprising virus-group eyes without ocular comorbidities.The follow-up indicators including graft survival rate,ECD,ECD loss,and central corneal thickness(CCT),were analyzed by Tukey honestly significant difference(HSD)test.RESULTS:Each group included 29 cases.The graft survival rate in CMV+group were lowest among the three groups(P=0.000).No significant difference in donor graft ECD was found among three groups(P=0.54).ECD in the CMV+group was lower than the virus-group at 12(P=0.009),and 24mo(P=0.002)after keratoplasties.Furthermore,ECD loss was higher in the CMV+group than in the virus-group in the middle stage(6-12mo)postkeratoplasty(P=0.017),and significantly higher in the early stage(0-6mo)in the virus-group than in the control group(P=0.000).CONCLUSION:CMV reduces the graft survival rate and exerts persistent detrimental effects on the ECD after keratoplasty.The graft ECD loss associate with CMV infection mainly occurrs in the middle stage(6-12mo postoperatively),while ocular comorbidities mainly affects ECD in the early stage(0-6mo postoperatively).
文摘AIM: To determine the incidence of cystoid macular edema(CME) after Descemet's stripping automated endothelial keratoplasty(DSAEK).METHODS: This study included all consecutive patients operated in a Spanish tertiary reference hospital over a period of four years. A total of 55 eyes from 47 patients matched the selection criteria. CME was diagnosed clinically at the slit-lamp and confirmed by optical coherence tomography. RESULTS: Six cases of CME were diagnosed postoperatively, which represented an incidence of 11%. Three patients had previously undergone DSAEK alone(7%; 3/41) and the other three, DSAEK combined with phacoemulsification(21%; 3/14). Five out of six patients with CME responded to standard therapy.CONCLUSION: CME is a possible complication after DSAEK and can be treated with standard therapy. CME appears more frequently when DSAEK is combined with phacoemulsification and posterior chamber(PC) intraocular lens(IOL) implantation. Intraoperative damage to the corneal endothelial cells might play a role in the pathogenesis of CME. As long as the causes remain unclear, we recommend administering prophylaxis when risk factors are present or when combined surgery is planned.
文摘AIM:To compare visual,surgical and topographic outcomes of deep anterior lamellar keratoplasty(DALK)and penetrating keratoplasty(PK)for keratoconus(KC).METHODS:In this multicenter,prospective,randomized clinical trial 76 eyes of 71 KC patients operated between January 2011 and July 2014 in 2 tertiary referral hospitals were included. Consecutive patients were alternately selected to receive one of the two surgical methods. Thirty eight eyes underwent DALK with the big-bubble technique and 38 eyes underwent PK.RESULTS:Mean best spectacle corrected visual acuity(BSCVA)at the first postoperative week(P=0.012)and the first postoperative month(P<0.001)was statistically significantly higher in DALK group. The mean BSCVA at12 mo was not significantly different for DALK(0.30±1.99 log MAR)versus PK(0.40±0.33 log MAR)(P=0.104). The76.3% of the eyes had a BSCVA over 0.5 in DALK and 47.4%in PK group(P=0.009). The 7.9% of the eyes had a BSCVA of 1.0 in DALK and 5.3% in PK group(P=0.644). Mean spherical equivalent was-2.94 D in DALK and-3.09 D in PK group.Mean topographic astigmatism was 4.62 D and 4.18 D respectively. Regular topographic patterns were observed in 31(81.6%)of DALK and 29(76.3%)of PK(P=0.574). The most frequent topographic pattern was oblate asymmetric bow tie,seen in 39.5% in DALK and 23.7% in PK. CONCLUSION:Big bubble DALK provides an earlier visual improvement compare to PK. However,visual and topographic outcomes are similar to those in PK at 1y. Postoperative complications including rejection and intraocular pressure elevation are more frequent in PK. DALK is a safer alternative to PK for KC. However,intraoperativeperforation of the Descemet's membrane is a significant complication.
文摘AIM: To evaluate the efficacy of a technical modification to reduce the incidence of traumatic cataract induced by Descemet stripping automated endothelial keratoplasty(DSAEK) performed in phakic eyes. METHODS: A retrospective cohort study. The records of all patients with a clear crystalline lens and endothelial failure that underwent modified DSAEK at our insitution were reviewed. In this modification, in order to avoid inadvertent touch of the insertion forceps against the exposed crystalline lens while passing across the anterior chamber, the incision sites were shifted from the standard 9 and 3 o'clock positions, superiorly to the 10 and 2 o'clock position respectively. Formation of typically traumatic, anterior subcapsular cataract in these patients was compared to that observed in a cohort including all the patients with a clear crystalline lens and endothelial failure that underwent conventional DSAEK at our institution.RESULTS: The study group included 49 eyes following modified DSAEK and the control group included 35 eyes following DSAEK with conventional incision sites. Anterior subcapsular cataract occurring 4 mo or less postoperatively was identified in 2 of 49(4%) eyes in the study group and 7 of 35(20%) eyes in the control group. The rates of traumatic cataract were significantly higher in the control group in comparison to the study group(P=0.03, RR=4.9, 95%CI 1.08-22.1).CONCLUSION: Traumatic cataract formation following phakic DSAEK may be avoided with a simple modification to the position of the incision sites.
基金Supported by Science Research Foundation of Aier Eye Hospital Group(No.AFl44D11)
文摘AIM: To investigate the impact of non-Descemet stripping endothelial keratoplasty(non-DSEK) on graft rejection rate,and its overall procedural effectiveness in patients.METHODS: Non-DSEK was performed on 65 eyes of 64 patients,and the procedural outcomes,including rejection episodes,failure and dislocation of the grafts,best corrected visual acuity(BCVA),endothelial cell density(ECD),and other complications,were analyzed retrospectively.RESULTS: Of the 65 eyes,63 recovered from bullous keratopathy with a clear cornea.The mean follow-up time was 26.4mo(range,6-84mo).The mean BCVA improved from 1.70 log MAR preoperatively to 0.54 log MAR at 3mo,0.46 logM AR at 6mo,and 0.37 logM AR at 1y after surgery.The postoperative donor ECD of the 25 patients who successfully underwent specular microscopic examination was 1918±534 cells/mm^2(range,637 to 3056 cells/mm^2),and the mean endothelial cell loss was 41.9% at 24 mo postoperatively.One eye developed secondary glaucoma and required regrafting via penetrating keratoplasty(PKP).Another eye had postoperative graft failure due to rejection at 26 mo.Postoperative graft dislocation occurred in eight eyes.All of the eight dislocated grafts were reattached using air reinjection.CONCLUSION: Immunological graft rejection of the donor graft rarely occurs in non-DSEK.Therefore,non-DSEK is a safe,concise,and effective alternative to restore corneal decompensation when the Descemet membrane is disease-free.
基金Supported by the National Natural Science Foundation of China (No.81500703)the Natural Science Foundation of Shandong Province (No.ZR2015YL027)the Innovation Project of Shandong Academy of Medica Sciences
文摘AIM: To review the indications of penetrating keratoplasty(PK) and anterior lamellar keratoplasty(ALK) at Qingdao Eye Hospital, Shandong Eye Institute, Qingdao, China, from 2010 to 2017. METHODS: The data of all patients undergoing PK or ALK from January 2010 to December 2017 was retrospectively reviewed, with the indications during 2010-2013 and 2014-2017 compared. RESULTS: A total of 1869 eyes were included, among which 1405 eyes(75.2%) had PK and 464 eyes(24.8%) had ALK. The leading indications were suppurative keratitis(36.8%), keratoconus(15.5%), herpes keratitis(13.1%), and regraft(10.5%). In eyes undergoing PK, the top four indications were suppurative keratitis(38.7%), herpes keratitis(15.3%), keratoconus(12.6%), and regraft(12.5%) during 2014-2017, with the proportion of suppurative keratitis and herpes keratitis decreased while regraft and keratoconus increased compared with 2010-2013. In eyes with ALK, suppurative keratitis(30.8%), keratoconus(24.1%), corneal dystrophies and degenerations(10.6%), and corneal dermoid tumor(9.7%) were the top four indications, and there was no significant difference for the proportion of each indication between 2010-2013 and 2014-2017. CONCLUSION: Suppurative keratitis is the most common indication for PK and ALK at Qingdao Eye Hospital during 2010-2017, followed by keratoconus, herpes keratitis, and regraft. In eyes treated with PK, the proportion of suppurative keratitis and herpes keratitis decrease while regraft and keratoconus increase during 2014-2017 compared with 2010-2013.
基金Supported by the Research to Prevent Blindness Unrestricted Grant(New York,USA)the National Eye Institute core grant(No.P30-EY14801)(Bethesda,Maryland,USA)
文摘To assess the postoperative outcomes of limbal dermoid excision with corneoscleral graft transplantation. The charts of 8 consecutive patients(mean age: 13.0 y) who had undergone limbal dermoid excision with lamellar corneoscleral graft transplantation by a single surgeon were retrospectively reviewed. Mean dermoid size was 7.75 mm(6.0-12.0 mm). Mean visual acuities(in log MAR units) before and after surgery were 1.8 and 1.7, respectively(P=0.29). Spherical equivalents were 1.3 diopter(D) before surgery and 0.7 D after surgery(P=0.40). The mean astigmatism measurements before and after surgery were 2.4 D and 1.5 D, respectively(P=0.17). Vector analysis revealed a mild change in astigmatism with a mean "d" of 3.2(0.56-6.89). No intra-or post-operative complications occurred. Lamellar keratoplasty for limbal dermoids is safe and offers good cosmesis and tectonic stability. A significant decrease in the amount of astigmatism is not expected following surgery.
文摘Purpose: To develop a new method of femtosecond laser-assisted refractive autokeratoplasty (FRAK) in advanced keratoconus and to evaluate preliminarily early clinical results. Methods: A total of 17 patients with stable advanced keratoconus and a mean age of 33 ± 8.4 years were included in the study. FRAK was performed in all cases with the IntraLase 60 kHz (Abbott Medical Optics Inc.). A 2-step resection of corneal stroma was performed using the femtosecond laser, with the generation of a circular corneal flap with wedge-shaped profile. After flap removal, the corneal wound was sutured. Results: The surgical procedure and early postoperative period were uneventful in all cases. Mean uncorrected distance visual acuity (UDVA) improved significantly from 0.07 ± 0.03 preoperatively to 0.26 ± 0.13 at 3 months after surgery. Improvement in corrected distance visual acuity (CDVA) was observed in 94.1% of cases, with 76.5% of eyes showing an improvement of more than 3 lines. Between 3 and 6 months after surgery, an additional improvement was observed in UDVA and CDVA. Corneal cylinder decreased significantly from 9.1 ± 3.8 D preoperatively to 4.4 ± 2.75 D at 6 months postoperatively. Conclusions: FRAK may be an alternative treatment in stable advanced keratoconus, allowing a significant visual improvement and corneal regularization while saving the patient's own corneal tissue. The non-penetrating nature of the surgical technique helps to minimize the risks associated to this type of surgery. Further research is needed to determine the functional long-term outcomes.
基金National Natural Science Foundation of China (No.81170825)
文摘AIM: To evaluate the effect of corneal graft diameter on therapeutic penetrating keratoplasty(PKP) for fungal keratitis. METHODS: A total of 116 patients (116 eyes) suffered from fungal keratitis underwent PKP at the Affiliated Hospital of Medical College Qingdao University from May 2006 to May 2010. They were divided into two groups according to the corneal graft diameter. 64 eyes' corneal graft diameter was 8.00mm or larger and 52 eyes' graft diameter was smaller than 8.00mm. The follow-up time was 2 years. The postoperative visual acuity and complications were documented and compared. RESULTS: Sixty-two (96.88%) eyes and fifty (96.15%) eyes preserved eyeballs respectively in two groups. There was no statistical difference in postoperative visual acuity (P =0.961), corneal graft clear rate (P =0.132) or the incidence of recurred fungal infection (P =0.770) between two groups. But there was a higher incidence of graft rejection (P =0.020) and secondary glaucoma (P =0.039) in group with corneal graft diameter 8.00mm or larger. CONCLUSION: PKP is an effective treatment approach for fungal keratitis. There is a higher incidence of complications in large-diameter PKP for fungal keratitis.Effective, preventive and therapeutic measures can improve the prognosis.
基金Supported by National Natural Science Foundation of China(No.30630063)
文摘AIM:To identify the current indications and the trend shifts for penetrating keratoplasty(PKP) in Shandong.METHODS:The medical charts of all patients who underwent PKP at Shandong Eye Institute from June 1,2005 to May 31,2010 were analysed retrospectively.RESULTS:A total of 875 patients(875 eyes) received PKP in this 5-year period,accounting for 61.6% of all corneal transplantation surgeries.The leading indications for PKP were infectious keratitis(37.1%),HSK(19.1%),keratoconus(11.2%),bullous keratopathy(8.5%),regrafting(6.7%) and corneal scarring(4.8%).The percentage of PKP for keratoconus declined year by year,whereas the percentage of bullous keratopathy had a mild annual increase.Fungal infections accounted for 65.2% of the infectious keratitis cases,remaining the leading cause of corneal infection.In addition,54.1% of bullous keratopathy cases were associated with cataract surgery.The leading initial diagnoses associated with regrafting were infectious keratitis(38.9%),HSK(18.6%) and corneal burn(16.9%).The major causes of regrafting included graft endothelial dysfunction(39.0%),graft ulcer(28.8%) and primary disease recurrence(15.3%).CONCLUSION:Infectious keratitis remained the leading indication for PKP in Shandong,and fungal infections were still the major cause of corneal infections.There was an increasing trend in the percentage of PKP cases indicated for bullous keratopathy but a decline in the same for keratoconus.Even with a decline in the overall proportion among all corneal transplantation surgeries,PKP is still the major corneal transplant choice in Shandong.
基金National Natural Science Foundation of China (No. 81270979)Natural Science Foundation of Jiangsu Province, China (No.BK2012777)
文摘·AIM: To describe the initial outcomes and safety of femtosecond laser-assisted deep anterior lamellar keratoplasty(DALK) for keratoconus and post-LASIK keratectasia.·METHODS: In this non-comparative case series, 10 eyes of 9 patients underwent DALK procedures with a femtosecond laser(Carl Zeiss Meditec AG, Jena,Germany). Of the 9 patients, 7 had keratoconus and 2had post-LASIK keratectasia. A 500 kHz VisuMax femtosecond laser was used to perform corneal cuts on both donor and recipient corneas. The outcome measures were the uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA), corneal thickness,astigmatism, endothelial density count(EDC), and corneal power.·RESULTS: All eyes were successfully treated. Early postoperative evaluation showed a clear graft in all cases. Intraoperative complications included one case of a small Descemet's membrane perforation.Postoperatively, there was one case of stromal rejection,one of loosened sutures, and one of wound dehiscence.A normal corneal pattern topography and transparency were restored, UCVA and BCVA improved significantly,and astigmatism improved slightly. There was no statistically significant decrease in EDC.· CONCLUSION: Our early results indicate that femtosecond laser-assisted deep anterior lamellar keratoplasty could improve UCVA and BCVA in patients with anterior corneal pathology. This approach shows promise as a safe and effective surgical choice in the treatment of keratoconus and post-LASIK keratectasia.
基金National Natural Science Foundation of China (No. 30973247)Shanghai Excellent University Teacher Foundation, China (No. 1500144019)
文摘Dear Sir, I am Dr Yan-Long Bi, from the Department of Ophthalmology, Tongji University Affiliated to Tongji University School of Medicine, Shanghai, China. I write to present a case report of total limbal stem cells deficiency after treatment with ring-shaped lamellar keratoplasty secondary to Terrien marginal degeneration. During 3
基金Supported by the Military Medical Science and Technology General Project During the 12thFive-Year Plan Period(No.CWS11J239)Autonomous Region of Xinjiang the Mandatory Project of Science and Technology(No.201491171)
文摘AIM: To demonstrate the changes in ultrastructure and histopathology of the cornea in acute corneal alkaline burns after femtosecond laser-assisted deep lamellar keratoplasty.·METHODS: The New Zealand white rabbits treated with alkaline corneal burn were randomized into two groups,Group A(16 eyes) with femtosecond laser-assisted deep lamellar keratoplasty 24 h after burn and Group B(16 eyes)without keratoplasty as controls. All eyes were evaluated with transmission electron microscopy(TEM) at 1, 2, 3,and 4wk follow-up, then all corneas were tested by hematoxylin and eosin staining histology.· RESULTS: The corneal grafts in Group A were transparent, while those in Group B showed corneal stromal edema and loosely arranged collagen fibers. One week after treatment, TEM revealed the intercellular desmosomes in the epithelial layers and intact non-dissolving nuclei in Group A. At week 4, the center of the corneas in Group A was transparent with regularly arranged collagen fibers and fibroblasts in the stroma. In Group B, squamous cells were observed on the corneal surface and some epithelial cells were detached.· CONCLUSION: Femtosecond laser-assisted deep lamellar keratoplasty can suppress inflammatory responses, prevent toxic substance-induced injury to the corneal endothelium and inner tissues with quicker recovery and better visual outcomes.
文摘Twenty samples of endothelia removed from normal and post penetrating keratoplas-ty (0.5,1,2,3 months after penetrating keratoplasty) were observed by scanning electron mi-croscopy.The photographs of the endothelia in graft-host junction were analyzed by computer-assisted image analysis system,and the morphometric indexes examined were area of the cells,perimeters,density,figure coefficient,long axis,coefficient of variation of the area,and oth-ers.Results showed that the morphology and the density of the endothelial cells changed obvi-ously after operation and improved slowly but progressively with time although at 3 monthspostoperatively some differences still existed.By using the new techniques,the experiment con-firmed and enriched the theories on the corneal endothelial wound-healing,revealing some ofthe new characters of the endothelial wound-healing following penetrating keratoplasty.
文摘AIM:To investigate the long-term results of penetrating keratoplasty(PK)in patients with keratoconus(KC)and to evaluate factors that might influence the final visual outcome.METHODS:We retrospectively reviewed the data of all patients with clinical KC who had undergone PK by a single corneal surgeon in a single center from May 1980to December 2005.The age of the patients,preoperative best-corrected visual acuity(BCVA),corneal thickness,death to preservation time,and preservation to transplantation time were recorded.Additionally,postoperative complications such as graft rejection,development of glaucoma and specular microscopy were checked during the follow-up.RESULTS:Sixty-nineeyesfrom69patientswerefinally included.The follow-up period was 8.64±6.13y.Graft rejection occurred in 4 eyes of 69 cases(5.8%),and the time to graft rejection was 2.1±1.3y.A Kaplan-Meier survival analysis showed that the estimated cumulative probability of graft rejection at 6,13,and 17y after PK were 95.6%,90.0%,and 78.8%,respectively.When we evaluated factors that might influence final BCVA in eyes,no disparity donor-host trephine size(same graft size)as well as higher spherical equivalent,and average Kvalue were associated with higher final BCVA.(P=0.006,0.051,0.092,and 0.021 in eyes with follow-up<8y;P=0.068,0.065,and 0.030 in eyes with follow-up≥8y,respectively).CONCLUSION:The long-term results of PK in patients with KC were favorable with a high percentage of good BCVA.Less myopic change and low average K-reading,as well as a surgical technique using the same size donor-recipient button may provide better visual outcomes particularly in patients with KC.
