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American journal of ophthalmology 02/2013; 155(2):406-7. · 3.83 Impact Factor
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ABSTRACT: To investigate the differences of long-term clinical outcomes between two kinds of corneal endothelial keratoplasty (EK): DSEK and DLEK.
Retrospective, comparative, clinical case series study. Twenty-six patients (26 eyes), undergoing DLEK and thirty-six patients (36 eyes), undergoing DSEK during the period of October 2005 to March 2008, were involved in this study. Before and at 6 month intervals after surgery, patients' data were collected to analyze the surgery success rate, graft dislocation rate, best corrected visual acuity (BSCVA), graft survival rate and endothelial cell density (ECD). The follow-up time was 3 to 5 years.
The success rate of DLEK was 88.5% while DSEK was 86.1%. Average BSCVA of DLEK were similar to those of DSEK at each follow-up time after 12 months postoperatively. Graft survival rates of DLEK and DSEK were respectively 87% and 75.9%, where as ECD were respectively 1638 cells/mm(2) and 1874 cells/mm(2) at 36 month postoperatively, the data were similar in both ECD and graft survival rate between DLEK and DSEK at 60 months postoperatively.
The success rate and long-term visual outcomes of DLEK were similar with those of DSEK. To obtain objective results, it is better to consider both ECD and graft survival rate instead of recording ECD only for its localization in evaluating the efficacy of EK.
[Zhonghua yan ke za zhi] Chinese journal of ophthalmology 10/2012; 48(10):920-3.
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ABSTRACT: To report clinical outcomes of deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in various original diagnoses.
Prospective interventional study.
Single hospital study of 115 unselected consecutive patients (131 eyes) with various diagnoses undergoing DALK using the big-bubble technique. The main outcome measures were intraoperative and postoperative complications, postoperative best spectacle-corrected visual acuity (BSCVA), and endothelial cell density (ECD).
Descemet membrane was exposed successfully in 25 eyes (80.6%) with advanced keratoconus, 11 (73.3%) with chemical or thermal burns, 20 (71.4%) with corneal dystrophy, 21 (70%) with a herpes simplex (HSK) keratitis scar, 4 (36.4%) with moderate keratoconus, and 5 (31.3%) with a bacterial keratitis scar (P < .05). Loosening of the sutures occurred in 24 eyes (23.8%) between postoperative4 and 7 months. Epithelial rejection was observed in 2 eyes and stromal rejection occurred in 5 eyes. BSCVA was improved in HSK scarring and corneal dystrophy vs keratoconus and corneal burns at 1 year (P < .05), but not after a mean follow-up of 21.4 months (P < .05). Patients who experienced stromal rejection had lower ECD than patients with no rejection at 18 and 24 months (P < .05). At all follow-up times after 6 months, patients with multiple air injection attempts had lower ECD than patients with 1 injection attempt (P < .05).
Different Descemet membrane exposure rates were observed in different diagnoses using the big-bubble technique. Both severe stromal rejection and additional manipulation may have a deleterious effect on the corneal endothelium.
American journal of ophthalmology 05/2012; 154(2):282-289.e1. · 3.83 Impact Factor
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ABSTRACT: Here we investigate the role of donor endothelium on allograft rejection in a lamellar keratoplasty (LK) model using grafts with or without donor endothelium.
Corneal buttons of donor C57BL/6 mice (2.0 mm) were transplanted to lamellar recipient beds (1.5 mm) in BALB/c mice. Two variations of the LK procedure were performed: (1) standard LK (SLK) (n = 13) without donor endothelium and (2) modified LK (MLK) (n = 14) with retained donor endothelium. The graft status was assessed by slit lamp biomicroscopy and scored for stromal opacity, corneal edema, neovascularization, and anterior chamber reaction up to 46 days post-transplantation. Corneas were also observed histologically.
The presence of a grafted corneal endothelium promoted graft rejection; 92.9% (13/14) of grafts were rejected in MLK after an average of 8.3 days, while 69.2% (9/13) of grafts were rejected in SLK on average 10.8 days after transplantation. The former's stromal opacity was significantly greater at all time points after day 14 except for day 21 (p = 0.77) and day 32 (p = 0.25). Corneal edema was significantly greater in the former at all time points after day 10 except for day 21 (p = 0.16). Neovascularization was significantly greater in the former at all time points after day 10 except for day 25 (p = 0.22). ConclusION: Variations of this model of LK may be useful for studies of immunological mechanisms in corneal transplantation. The donor corneal endothelium may serve as a target of the immune response which promotes inflammation, neovascularization, and graft rejection.
Ophthalmic Research 10/2011; 47(3):128-34. · 1.56 Impact Factor
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ABSTRACT: To evaluate outcomes of limbal allograft transplantation from living-related donors to treat partial limbal deficiency secondary to ocular chemical burns.
Retrospective noncomparative case series comprising 17 patients (17 eyes) with partial limbal deficiency (≤50%) secondary to ocular alkali burns (11 eyes) or acid burns (6 eyes). Recipient eyes were treated by removing the conjunctivalized pannus. Superior limbal grafts (mean length, 3-5 clock hours) from HLA antigen-matched living-related donors were transplanted into deficient areas of recipient eyes. No recipients received systemic cyclosporin A therapy. Main outcome measures included corneal reepithelialization, reduction in vascularity, improved corneal clarity, and best-corrected visual acuity.
All eyes achieved epithelialization a mean (SD) of 10.1 (1.9) days after surgery. Corneal reepithelialization, reduction in vascularity, and improved corneal opacity were seen in all eyes. No eyes demonstrated recurrent epithelial defects or fibrovascular tissue, but gradual recurrence of peripheral corneal vascularization was observed in 7 eyes during the follow-up period. Allograft rejection developed in 3 eyes (17.6%), all of which were successfully treated. Best-corrected visual acuity improved in all eyes, and 10 eyes (58.8%) had achieved best-corrected visual acuity of 0.5 or better (≥20/10 Snellen) at the last follow-up visit.
Transplantation of limbal tissue from live-related donors successfully reconstructed the ocular surface. Long-term graft survival in patients with partial limbal deficiency secondary to ocular chemical burns can be accomplished without the use of systemic immunosuppression.
Archives of ophthalmology 10/2011; 129(10):1267-73. · 3.86 Impact Factor
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ABSTRACT: To determine the efficacy and postoperative complications of simple Descemet's stripping endothelial keratoplasty (DSEK) for treatment of special Fuchs' endothelial dystrophy in phakic eyes.
Six eyes with clear crystalline lenses in 5 consecutive patients with Fuchs' endothelial dystrophy underwent DSEK and were followed up for 12-27 months. The pupil was constricted preoperatively to 1.5 mm in diameter. The anterior chamber was deepened intraoperatively by injection of balanced salt solution to unfold the donor graft and to protect the crystalline lens. Best corrected visual acuity, corneal astigmatism, corneal curvature, corneal thickness, and anterior chamber depth were recorded preoperatively and at 6 and 12 months postoperatively. Average endothelial cell density and endothelial cell loss (ECL) were recorded at 6 and 12 months postoperatively.
DSEK was successfully performed in all 6 eyes. No graft dislocation or lens injury occurred. One of the 6 eyes presented with mild cataract at 12 months after surgery but showed no sign of progressive cataract development during the follow-up. All grafts were clear during the last follow-up: best corrected visual acuity ranged from 20/50 to 20/30, average corneal astigmatism was 2.2 ± 0.6 dpt, average corneal curvature was 46.0 ± 2.4 dpt, and average central corneal thickness was 583.0 ± 21.5 μm. At 6 and 12 months postoperatively, average endothelial cell density was 2,070.7 ± 206.1 cells/mm(2) (28.0 ± 7.5% of ECL) and 1,838.3 ± 194.5 cells/mm(2) (36.1 ± 6.2% of ECL), respectively.
Simple DSEK might be a feasible option for Fuchs' endothelial dystrophy in young patients with clear crystalline lenses.
Ophthalmic Research 01/2011; 46(1):44-9. · 1.56 Impact Factor
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ABSTRACT: To investigate the efficacy and complications of limbal allografting from related live donors (RL-LAT) for limbal stem cell deficiency secondary to ocular chemical burn.
Retrospective comparative case series. Limbal allografting from related live human leukocyte antigen (HLA)-matched (n = 10) and-unmatched donors (n = 2) was performed in 12 consecutive patients (12 eyes) with limbal stem cell deficiency secondary to ocular chemical burn, including 9 alkali burn and 3 acid burn; whereas allolimbal cadaver transplant was performed in another 15 patients in Zhongshan Ophthalmic Center between April 2006 to December 2007. Systemic cyclosporine A was administered to later eight recipients in living related donor group and all patients in cadaver donor group. Main outcome measures were restoration of corneal epithelium, reduction in corneal vascularization, improved corneal clarity, and visual improvement. Mean follow-up was (11.4 ± 3.6) months (from 12 to 27).
In living related donor group, ten patients (83.3%) achieved initially reepithelialize, and epithelial healing time was (9.6 ± 3.4) d. Nine patients (75.0%) achieved stable ocular surface (stable corneal epithelium, decreased vascularization of corneal surface, and reduced corneal opacification). However, in seven eyes (77.8%) achieved stable ocular surface, gradual recurrence of peripheral corneal vascularization occurred after 5 to 8 months postoperatively. Whereas in cadaver donor group, twelve patients (80.0%) achieved initially reepithelialize, and epithelial healing time was (11.2 ± 4.6) d. Seven patients (46.7%) achieved stable ocular surface. However, in all seven eyes achieved stable ocular surface, gradual recurrence of peripheral corneal vascularization occurred after 4 to 10 months postoperatively. The differences of both the rate of initially reepithelialize and epithelial healing time between these two groups showed no statistical significance (χ(2) = 1.764, P = 0.117; t = 0.116, P = 0.133, respectively). However, the differences of both the successful rate of ocular surface reconstruction and the recurrent rate of corneal vascularization during the follow-up period between these two groups were statistically significant (χ(2) = 4.158, P = 0.015; χ(2) = 3.463, P = 0.022, respectively). In living related donor group, features of graft rejection developed in two patients with postoperative stable ocular surface, Both rejected recipients had one among HLA-matched and one among-unmatched respectively. Whereas in cadaver donor group, features of graft rejection developed in three patients with postoperative stable ocular surface. None of the donor eyes had any complications.
Limbal allografting from related live donors is more effective to reconstruct the ocular surface of limbal stem cell deficiency secondary to ocular chemical burn than allolimbal cadaver transplant. HLA-matched limbal allografting could reduce postoperative graft rejection and systemic cyclosporine A is useful in ensuring long-term survival.
[Zhonghua yan ke za zhi] Chinese journal of ophthalmology 09/2010; 46(9):775-80.
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Ting Huang
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ABSTRACT: Endothelial keratoplasty (EK) demonstrates many advantages over penetrating keratoplasty (PK), which is expected to become an initial surgical choice for the treatment of corneal endothelial dysfunction, instead of PK. However, EK also has the defects in the low density of endothelial cells after surgeries. And the bullous keratopathy in China is mainly caused by intraocular surgeries such as cataract extraction, which was accompanied by a variety of intraocular abnormalities. The complex cases will undoubtedly make the surgeries more difficult, and make endothelial cells density lower after surgeries. It is the most important that a suitable surgical procedure and the indications were selected on the basis of the patients' clinical characteristics. Adoption of some modified EK techniques can reduce postoperative endothelial cell loss, which can improve the successful rate of surgeries.
[Zhonghua yan ke za zhi] Chinese journal of ophthalmology 05/2010; 46(5):391-4.
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ABSTRACT: To investigate the feasibility, efficacy, and complications of the temporary anchor sutures for endothelial graft fixation in Descemet stripping endothelial keratoplasty (DSEK) in aphakic eyes.
Non-randomized retrospective case series. Twelve consecutive cases (12 eyes) with aphakic bullous keratopathy underwent DSEK using the temporary anchor sutures technique for fixation of donor button in Zhongshan Ophthalmic Center between April to December in 2007. All cases were resulted from lens extraction and best spectacle-corrected visual acuity (BSCVA) was inferior or equal to 0.04. Eight cases were with preoperative pain. Prospective data of BSCVA, corneal astigmatism, curvature and thickness were collected on all 12 eyes preoperatively and at 3, 6 and 12 months postoperatively. Average endothelial cell density (ECD) and endothelial cell loss (ECL) were recorded at 6 and 12 months postoperatively. The follow-up period was 12 to 20 months.
All cases were performed DSEK successfully using the temporary anchor sutures and the grafts were well-attached without dislocation. On postoperative day 1, papillary block glaucoma occurred in 2 eyes and mannitol 20% was administered intravenously. The intraocular pressure in the 2 eyes returned to normal due to the air bubble absorption on postoperative day 2. The endothelial grafts showed mild to moderate edema in all eyes and became clear in 8 to 15 days postoperatively. All the corneas were clear during follow-up. In 12 months postoperatively, BSCVA was 0.7 in 16.7% of eyes (n = 2), 0.5 in 25.0% of eyes (n = 3), 0.4 in 33.3% of eyes (n = 4), and 0.3 in 25.0% of eyes (n = 3); mean corneal astigmatism was (2.40 + or - 0.70) diopters, mean corneal curvature was (45.40 + or - 1.50) diopters, and mean corneal thickness was (591.5 + or - 20.4) microm. Mean endothelial cell density (ECD) was (2088 + or - 146) cells/mm(2) [(28.9 + or - 3.9)% endothelial cell loss] and (1857 + or - 101) cells/mm(2) [(36.7 + or - 3.1)% endothelial cell loss] in 6 and 12 months postoperatively, respectively.
The temporary anchor sutures technique was easy to perform and effectively prevented graft dislocation and detachment into the vitreous cavity.
[Zhonghua yan ke za zhi] Chinese journal of ophthalmology 03/2010; 46(3):233-7.
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ABSTRACT: To evaluate the feasibility, efficacy and postoperative complications of Descemet stripping endothelial keratoplasty (DSEK) with paediatric donor tissue.
Retrospective non-comparative interventional case series. Seven consecutive cases (seven eyes) of pseudophakic bullous keratopathy were treated with DSEK using paediatric donor tissue and followed up for 12 to 18 months. Data collected included best spectacle-corrected visual acuity, spherical equivalent refractive error, corneal astigmatism, corneal curvature and endothelial cell density.
DSEK was successfully performed in six out of seven eyes with paediatric donor graft; one paediatric donor graft perforated during dissection. All paediatric tissue was unfolded using the "hitch suture" technique and supported with plenty of air. No graft dislocation occurred. At 12 months postoperatively, the cornea was clear in all eyes; the best spectacle-corrected visual acuity ranged from 20/67 to 20/32; the average spherical equivalent refractive error was 1.9 (0.5) dioptres; the average corneal astigmatism was 2.2 (0.6) dioptres; the average corneal curvature was 45.2 (1.6) dioptres; and the average endothelial cell density was 2247.7 (74.3) cells/mm(2) (41.4 (3.7)% of endothelial cell loss).
With high postoperative endothelial cell counts, low graft dislocation rate and absence of high myopic shifts, paediatric donor tissue can be successfully used in DSEK.
The British journal of ophthalmology 08/2009; 93(12):1625-8. · 2.92 Impact Factor
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ABSTRACT: To investigate the indications, surgical procedure, clinical efficacy, and the prevention and management of complications of Descemet's stripping with endothelial keratoplasty (DSEK) for bullous keratopathy.
In the nonrandomized retrospective consecutive case series, 8 patients (8 eyes) with bullous keratopathy at Zhongshan Ophthalmic Center between September 2006 and October 2007 underwent DSEK surgery. During the surgical procedure, the Descemet's membrane and abnormal endothelial layer were stripped from the central recipient posterior surface with 7.75 mm diameter, and then a specially designed scraper was used to roughen the peripheral recipient posterior stroma. Other surgical techniques were the same with routine DSEK surgery. The adherence of the donor lenticule to the recipient posterior stroma and postoperative donor lenticule dislocation were monitored in the early stage after surgery. Best spectacle-corrected visual acuity (BSCVA), graft clearance, corneal astigmatism and endothelial cell density (ECD) were observed over a 3-9 months follow-up period.
All donor lenticules were well adherent to the recipient posterior stroma and no graft dislocation occurred postoperatively. One patient had papillary block glaucoma at 1-day, and relieved after 48 hours postoperative. All grafts remained transparent, and had improved visual acuity. BSCVA was 0.3 - 0.7 postoperative. Six patients with preoperative pain had been pain free after DSEK procedure. Mean corneal astigmatism was (1.90 +/- 0.70) diopter (D). Mean ECD was (2014 +/- 192) cells/mm(2).
Compared with deep lamellar endothelial keratoplasty (DLEK), DSEK procedure is technically easier and less traumatic to recipient cornea and anterior chamber structures. The skill of roughening the peripheral recipient posterior stroma should prevent postoperative graft dislocation effectively.
[Zhonghua yan ke za zhi] Chinese journal of ophthalmology 06/2009; 45(5):430-5.
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ABSTRACT: To explore the clinical value and management of complications of the transplantation of Titanium skirt compounded keratoprosthesis for severe corneal blindness eyes.
It was a retrospective case series study. Nine eyes from 9 male patients, aged 28 to 52 years old, accepted permanent keratoprosthesis transplantation in Zhongshan Ophthalmic Center from March 2002 to June 2005. All patients had corneal lesion in both eyes for 1.5 to 5.0 years. Among the 9 treated eyes, 6 eyes was severe vascularization after alkali burns, 3 eyes explosive injuries. Light perception was remained in all patients before surgery, however, 2 eyes only had a questionable orientation of light perception among them. Surgical management was divided into two stages. In the first stage, transplantation of Titanium skirt compound keratoprosthesis was performed, and the explant was reinforced by the self auricular cartilage and Tendons capsule. The second stage of surgery was performed in 5 to 6 months later, in which the membrane in the front of keratoprosthesis was cut. After the surgery, visual acuity, visual field, intraocular pressure and retina were examined. The complications were noticed and managed.
All treated eyes were followed up for 1 to 3 years. After the treatment, 7 eyes divorced from blindness with uncorrected visual acuity 20/200 (0.1), and 2 eyes among them got corrected visual acuity 20/30 (0.6). Two eyes with the questionable orientation of light perception before treatment gained uncorrected visual acuity 4/200 (0.02) and 8/200 (0.04) after treatment respectively. Complications were found to include 5 recurrent frontal membrane of keratoprosthesis, one back membrane of keratoprosthesis, and one limited corneal melting. Complications were controlled by the corresponding treatments, such as membrane resection for the recurrent frontal membrane of keratoprosthesis, courage under microscope for back membrane of keratoprosthesis, and reinforcement of acellular dermis for corneal melting. All keratoprosthesis were maintained in situ, and no rejection and leakage of aqueous humor happened.
It is effective to use transplantation of keratoprosthesis for the severe corneal blindness eyes. Combination with self auricular cartilage and Tendons capsular reinforcement may reduce the complications and improve the biocompatibility of keratoprosthesis.
[Zhonghua yan ke za zhi] Chinese journal of ophthalmology 03/2009; 45(2):104-9.
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ABSTRACT: To determine the efficacy and postoperative complications of complex deep lamellar endothelial keratoplasty (DLEK) when used for the management of complex bullous keratopathy with severe vision loss.
Twelve consecutive eyes with severe bullous keratopathy and other associated intraocular abnormalities underwent complex DLEK which was combined with other intraocular surgeries such as vitrectomy, intraocular lens removal, and secondary intraocular lens implantation. An air bubble was used in 9 eyes and an air and C3F8 gas bubble in 3 eyes for tissue support. Prospective data of best spectacle-corrected visual acuity, corneal astigmatism, and curvature were collected on all 12 eyes preoperatively and at 6, 9, and 12 months postoperatively. Average donor endothelial cell density was recorded preoperatively and at 9 months postoperatively.
Preoperatively, severe visual loss was recorded at hand motions (n = 3), count fingers (n = 7), and 20/400 (n = 2). Best spectacle-corrected visual acuity improved in 83% of eyes with vision of 20/67 or better in 42% (5/12) and 20/100 or better in 66% (8/12) of eyes at 12 months postoperatively. Vision was not improved in three eyes due to coexistent retinal disease. Four aphakic eyes underwent secondary intraocular lens implantation later at 4-6 months after DLEK, and best spectacle-corrected visual acuity was increased from count fingers to 20/200 or better. At 12 months postoperatively, average corneal astigmatism and curvature were 2.3 +/- 0.5 diopters and 44.0 +/- 0.9 diopters, respectively. Average central corneal thickness at 12 months postoperatively (541.3 +/- 26.7 microm) was significantly thinner than that before surgery (673.8 +/- 77.5 microm, P < 0.01). Preoperative average donor endothelial cell density was 2685.1 +/- 193.9 cells/mm. At 9 months postoperatively, average endothelial cell density was 1920.1 +/- 94.0 cells/mm (27.3% of endothelial cell loss) in eyes with primary surgery and 1866.3 +/- 92.8 cells/mm (33.9% of endothelial cell loss) in eyes with secondary surgery. Postoperative complications usually occurred within 3 months of surgery. After surgery, 3 eyes showed narrow gaps between the border of the graft and the host. Epithelial bullae in these areas recurred in 2 eyes but disappeared within 3 months. There was one graft dislocation in this series, no pupillary block cases, and no primary graft failures.
In cases of complex bullous keratopathy with severe vision loss, DLEK combined with other intraocular surgeries is a feasible and effective procedure to significantly improve visual acuity to a functional level in most patients. DLEK can be used successfully in eyes with aphakia and other anterior segment abnormalities without a high risk of graft dislocation or failure. Mild postoperative complications usually occurred early after DLEK and did not affect visual outcomes and graft survival if managed appropriately.
Cornea 02/2009; 28(2):157-62. · 1.73 Impact Factor
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ABSTRACT: To evaluate the efficacy and postoperative complications of deep lamellar endothelial keratoplasty (DLEK) for treating iridocorneal endothelial (ICE) syndrome in phakic eyes.
Retrospective noncomparative interventional case series. Seven consecutive patients (7 eyes) having ICE syndrome with clear or mildly opaque lens were treated using DLEK and were followed up for 9 to 20 months. Data collected included best spectacle-corrected visual acuity, intraocular pressure, corneal astigmatism, endothelial cell density, and peripheral iris and anterior chamber angles using ultrasonographic biomicroscopy.
Corneas were clear in all eyes. No graft dislocation or lens injury occurred. During the follow-up period, 2 eyes developed cataract, 1 of which underwent phacoemulsification and intraocular lens implantation; 2 eyes had elevated intraocular pressure, 1 of which underwent filtering valve implant surgery; and 3 eyes showed progressive peripheral anterior synechiae. At the last follow-up, best spectacle-corrected visual acuity ranged from 20/67 to 20/30; the mean (SD) corneal astigmatism was 2.0 (0.7) diopters (D); and the mean (SD) corneal curvature was 44.6 (1.5) D. The mean (SD) endothelial cell density was 1917 (156) cells/mm(2) 9 months after surgery.
DLEK is efficacious in the treatment of ICE syndrome in phakic eyes, with rapid visual rehabilitation and low incidence of postoperative complications. DLEK may be a good option for ICE syndrome in phakic eyes.
Archives of ophthalmology 02/2009; 127(1):33-6. · 3.86 Impact Factor
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ABSTRACT: To discuss the efficacy and visual outcomes of different types of lamellar keratoplasty (LK) for the treatment of peripheral corneal perforation.
Sixty patients (67 eyes) with peripheral corneal perforation underwent semilunar LK (16 eyes), crescentic LK (12 eyes), biconvex LK (13 eyes), annular LK (11 eyes) and total LK (15 eyes) respectively. The applied type of LK for each involved eye was decided by different sizes and shapes of corneal ulceration and perforation. Postoperative visual acuity (VA), corneal astigmatism and postoperative complications were studied during a 7- to 21-month follow-up.
VA showed no statistical difference preoperatively (P = 0.18), but it was statistically different postoperatively (P < 0.01) in eyes with different types of LK. Postoperative VA in eyes with semilunar LK, crescentic LK and total LK was statistically better than that before surgery (all P values <0.05). Postoperative corneal astigmatism in different types of LK was statistically different (P < 0.01). Semilunar and crescentic LK had the lowest astigmatism, while biconvex LK had the highest. The main postoperative complications were leakage at the graft-host interface, graft rejection and initial disease recurrence.
LK is an effective procedure in eyes with peripheral corneal perforation. Different sizes and shapes of LK can influence postoperative VA due to different degrees of astigmatism. Yet postoperative astigmatism can be reduced by making well-matched grafts and preserving the uninvolved tissue to the largest extent.
Albrecht von Graæes Archiv für Ophthalmologie 09/2008; 246(8):1123-31. · 2.17 Impact Factor
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ABSTRACT: To investigate the efficacy, postoperative complications and management of deep lamellar endothelial keratoplasty (DLEK) in complex cases of severe bullous keratopathy.
In the nonrandomized retrospective consecutive case series, fifteen cases (15 eyes) of severe and complex bullous keratopathy at Zhongshan Ophthalmic Center underwent DLEK in combination with other intraocular surgeries between October 2005 and March 2006. DLEK was combined with vitrectomy and ciliary sulcus sutured intraocular lens implantation in two patients, with vitrectomy and intraocular lens extraction in two patients and with vitrectomy and intraocular lens exchange in one patient Four patients with aphakic eyes underwent subsequent ciliary sulcus sutured intraocular lens implantation within 4 to 6 months after the DLEK donor tissue had been placed. The best spectacle corrected visual acuity (BSCVA), corneal astigmatism, curvature and endothelial cell density (ECD) were examined preoperatively and postoperatively. The graft-host interface was photographed by anterior segment optic coherent tomography (OCT). Repeated Measures Anova was applied for management of the data.
On postoperative day 1, 13 grafts were well attached to the host except for one dislocation (re-located immediately and well attached). Fluid leakage between the graft-host interface occurred in one eye (absorbed on day 5). All the grafts remained clear during the follow-up. Five cases (33.3%) showed narrow gaps between the borders of graft and host. Bullous epithelial lesion reoccurred above the gap in two cases (13.3%), and disappeared during follow-up. BSCVA in 4 eyes (26.7%) was 0.4, in 3 eyes (20.0%) was 0.3, in 4 eyes (26.7%) was 0.2, and in 1 eye (6.7%) was 0.1 after DLEK. At 6, 9 and 12 months, the average corneal astigmatism were (2.80 +/- 0.70) D, (2.60 +/- 0.70) D and (2.20 +/- 0.60) D (F = 5.591, P = 0.090), average corneal curvature were (43.60 +/- 1.90) D, (44.10 +/- 1.30)D and (44.10 +/- 1.00) D (F =1.515, P = 0.237). The average central corneal thickness were (666.1 +/- 70.6) microm, (544.5 +/- 30.9) microm, (538.2 +/- 34.7) microm and (532.4 +/- 41.6) microm (F = 32.692, P = 0.000) at preoperatively, 6, 9 and 12 months postoperatively, respectively. The mean ECD was (1915.7 +/- 90.8) cells/mm2 postoperatively.
DLEK surgery is an effective and safe procedure in severe and complex cases of bullous keratopathy,but it has to be successfully combined with other anterior segment surgeries. DLEK graft without sutures can tolerate subsequent other anterior segment surgeries at 4 to 6 months after placement of the donor tissue.
[Zhonghua yan ke za zhi] Chinese journal of ophthalmology 09/2008; 44(8):726-33.
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ABSTRACT: To explore the indications, efficacy, and complications of different types of lamellar keratoplasty (LKP) for peripheral corneal perforation.
In our nonrandomized retrospective case series, 40 cases (42 eyes) with peripheral corneal perforation at Zhongshan Ophthalmic Center between January 2003 and June 2006 underwent semi lunar LKP (14 eyes), crescent LKP (11 eyes), biconvex LKP (7 eyes), ring-shaped LKP (5 eyes), and total LKP (5 eyes). The selection of various procedures was based on the size and shape of corneal ulceration and perforation. Postoperative visual acuity (VA), corneal clarity, astigmatism, and complications were studied during a follow-up of 3 to 21 months. The initial causes and recurrence for peripheral corneal perforation were analyzed.
The initial causes of corneal perforation were mostly Terrien's marginal degeneration (35.7%), Mooren's ulcer (31.0%), herpes simplex keratitis (11.9%), chemical/thermal burns (9.5%), and corneal ecstatic diseases (7. 1%). The lamellar graft attached to the host well and was transparent in 34 eyes (81.0%) following LKP. VA less than 0.1 were presented in 13 eyes (31.0%) preoperatively and in 3 eyes (7.1%) postoperatively. VA in 27 eyes (64.3%) improved after LKP, and best-corrected VA in nine eyes (21.4%) was 0.5 or better. The mean corneal astigmatism was (7.23 +/- 1.22) D three months postoperatively, and this decreased to (3.72 +/-1.76) D in six to nine months postoperatively when sutures were removed. The postoperative complications included graft-host interface effusion (8 eyes, 19.1%), secondary glaucoma (8 eyes, 19.1%) and reoccurrence of primary diseases, including Mooren's ulcer (3 eyes, 23. 1%) and herpes simplex keratitis (1 eye, 20.0%).
LKP is effective to restore the integrity of the eyes with peripheral corneal perforation. Choosing the appropriate type of LKP based on different shape of corneal perforations can remove the corneal lesion and spare the normal tissue to the maximum. Moreover, the well-matched graft configuration can reduce the postoperative astigmatism, helping restore or improve the vision in most cases.
[Zhonghua yan ke za zhi] Chinese journal of ophthalmology 03/2008; 44(2):104-10.
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ABSTRACT: To evaluate the efficacy and safety of keratoplasty combined with corneal foci resection in the treatment of Terrien's marginal degeneration (TMD).
In this nonrandomized retrospective case series, the records of 48 eyes from 40 patients with TMD who received keratoplasty from January 1995 to December 2005 in Zhongshan Ophthalmic Center were reviewed retrospectively. Orbscan topography examination was undertaken in 8 eyes of 8 patients and the refractive error of 9 eyes from 9 patients was tested before and after the operation.
The mean age of the patients was (30 +/- 6) years old. The mean follow up period was (7 +/- 6) years. It took (3 +/- 1) months postoperatively to obtain a stable visual acuity. Before operation, the naked eye and best corrected visual acuity (VA) (Q25,Q75) were (0.05,0.4), and (0.1,0.5), respectively, while improved to (0.2,0.6) and (0.4,0.7) after operation, respectively (Z = 4.63, 3.85, both P<0.01). VA was improved in 39 eyes (81.3%), remained at the same level in 4 eyes (8.3%), decreased 1-2 lines in 3 eyes (6.3%), and decreased more than 2 lines in 2 eyes (4.1%) after the operation. The median spherical diopter and cylinder diopter were (-2.00 D, -8.50 D) and (2.50 D,12.00 D) before operation, while decreased to ( -1.25 D, -4.75 D) and (0.75 D, 4.25 D) after operation (Z= 2. 49, 2.54, P = 0.01, 0.01). The improvement in Sim K's astigmatism, astigmatism in 3 mm zone and mean power in 3 mm and 5 mm zone were reduced statistically significant after the operation (P <0.05); with the exception of astigmatism in the 5 mm zone, which was not reduced significantly after the operation (Z = 1.86, P = 0.06) . The operative complications included corneal perforation during operation in 5 eyes (10.4%), hydrops between graft and recipient interface in 8 eyes (16.7%), epithelial in-growth in 4 eyes (8.3%), choroidal detachment in 1 eye (2.1%), graft rejection in 7 eyes (14.6%), and recurrence in 3 eyes (6.3%). Secondary surgery was required in 5 eyes (10.4%) for interface hydrops, epithelial in-growth and recurrence of TMD.
Keratoplasty combined with foci resection is effective and safe in the treatment of TMD. This procedure can preserve and improve the visual activity.
[Zhonghua yan ke za zhi] Chinese journal of ophthalmology 03/2008; 44(2):116-21.
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ABSTRACT: To study the changes of tear film after recovery from acute conjunctivitis.
This study involved 73 eyes of 56 consecutive patients who complained of dry eye after recovery from acute conjunctivitis at the Zhongshan Ophthalmic Center. Excluded were other factors that could affect the stability of the tear film. Tear film breakup time (BUT), Schirmer 1 test (S1T), tear meniscus height (TMH), and fluorescein staining (FL) were performed on both recovered and healthy eyes. The scores were measured at 3, 7, 14, 21, and 30 days after recovery.
Compared with the results of the healthy eyes, most scores of BUT, S1T, TMH, and FL were all abnormal until day 30 after recovery from acute conjunctivitis. BUT decreased at 3, 7, 14, and 21 days (P < 0.05). S1T decreased at 3, 7, and 21 days (P < 0.05). TMH values became less than normal at 3, 7, and 14 days (P < 0.05). FL increased significantly at 7, 14, and 21 days (P < 0.05). At 30 days after recovery, all of the test scores returned to normal (P > 0.05).
During acute conjunctivitis, inflammation and topical therapeutic agents can alter the tear film secretion, resulting in dry eye for nearly 1 month in recovered eyes. To minimize the effect of topical agents to the tear film, individualized treatment instead of frequent instillation of topical agents is recommended for acute conjunctivitis.
Cornea 08/2007; 26(7):778-81. · 1.73 Impact Factor
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ABSTRACT: To observe the effect of semiconductor (diode) laser endocyclic-photocoagulation (ECP) on the survival of corneal grafts for patients with uncontrolled refractory glaucoma secondary to penetrating keratoplasty (PKP).
Thirty-four eyes of 34 patients with refractory glaucoma were prospectively assigned to diode laser ECP in 12 eyes, and diode laser ECP with anterior vitrectomy in 22 eyes in Zhongshan Ophthalmic Center from March 2000 to April 2004 as ECP group. Twenty-six eyes of 26 patients were underwent trans-scleral cyclophotocoagulation (TCP) as TCP group. The preoperative and postoperative follow-up parameters evaluated included visual acuity (VA), intraocular pressure (IOP), corneal graft clearance, endothelial cell density (ECD), anterior chamber inflammation, ciliary processes and chamber angle (viewed under ultrasonic biomicroscope, UBM), and the postoperative complications were recorded as well.
In ECP group, a mean of (2.7 +/- 1.3) glaucoma medications was used with mean preoperative IOP value of (40.1 +/- 9.6) mm Hg preoperatively. IOP was decreased (below 21 mm Hg) in 13 eyes (38.2%) 3 months postoperatively. Six months after ECP, decreased IOP (below 21 mm Hg) was obtained in 23 eyes (67.7%). In TCP group, a mean of (2.3 +/- 1.5) glaucoma medications were administrated with mean preoperative IOP value of (41.4 +/- 10.4) mm Hg preoperatively. IOP was decreased (below 21 mm Hg) in 10 eyes (38.5%) 3 months postoperatively. Six months after TCP, decreased IOP (below 21 mm Hg) was obtained in 8 eyes (30.8%). The difference of IOP reduction between these two groups showed no statistical significance 3 months postoperatively (chi(2) = 0.0003, P = 0.986), but it was statistically significant after 6 months (chi(2) = 8.024, P = 0.005). In ECP group, 25 eyes had clear corneal grafts preoperatively, with mean ECD of (1353 +/- 293) cells/mm(2). Postoperative mean ECD was (1013 +/- 170) cells/mm(2). In TCP group, 20 eyes had clear corneal grafts preoperatively, with mean ECD of (1221 +/- 191) cells/mm(2). Postoperative mean ECD was (847 +/- 136) cells/mm(2). The difference of ECD between ECP and TCP group was statistically significant (t = -0.009, P = 0.033). Reactive no-specific inflammation in anterior chamber occurred in 9 eyes (26.5%) in ECP group and 21 eyes (80.8%) in TCP group, which showed statistical significance (chi(2) = 17.376, P = 0.001).
ECP proved more efficacious than TCP in controlling IOP in patients with post-penetrating keratoplasty glaucoma in long-term observation. Compared with TCP, ECP shows less corneal graft endothelial cell loss, and comparatively mild post-ECP uveitis, which improves the survival of corneal grafts greatly.
[Zhonghua yan ke za zhi] Chinese journal of ophthalmology 05/2007; 43(4):313-8.
