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Midterm outcomes of penetrating keratoplasty following allogeneic cultivated limbal epithelial transplantation in patients with bilateral limbal stem cell deficiency

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International Journal of Ophthalmology(English edition) 2021年第11期14卷 1690-1699页

作者： Jun-Fa Xue Dong-Fang Li Ya-Ni Wang Chen Chen Ru-Fei Yang Qing-Jun Zhou Ting Liu Li-Xin Xie Yan-Ling Dong School of Medicine and Life Sciences Shandong First Medical UniversityJinan 271016Shandong ProvinceChina State Key Laboratory Cultivation Base Shandong Province Key Laboratory of OphthalmologyShandong Eye InstituteShandong First Medical University&Shandong Academy of Medical SciencesQingdao 266071Shandong ProvinceChina Medical College Qingdao UniversityQingdao 266071Shandong ProvinceChina Department of Ophthalmology Shandong UniversityJinan 250100Shandong ProvinceChina Qingdao Eye Hospital of Shandong First Medical University Qingdao 266071Shandong ProvinceChina

AIM:To evaluate the midterm outcomes of penetrating keratoplasty(PK)following allogeneic cultivated limbal epithelial transplantation(CLET)for bilateral total limbal stem cell deficiency(LSCD).METHODS:Ten patients(10 eyes)with bilateral LSCD were enrolled in this prospective noncomparative case series *** participant underwent PK approximately 6 mo after a *** tacrolimus,topical and systemic steroids,and oral ciclosporin were administered ***-corrected visual acuity(BCVA),intraocular pressure(IOP),ocular surface grading scores(OSS),corneal graft epithelial rehabilitation,persistent epithelial defect(PED),immunological rejection,and graft survival rate were ***:The time interval between PK and allogeneic CLET was 6.90±1.29(6-10)*** improved from 2.46±0.32 log MAR preoperatively to 0.77±0.55 log MAR post-PK(P<0.001).Kaplan-Meier analysis of mean graft survival revealed graft survival rates of 100%at 12 and 24 mo and 80.0%at 36 *** appeared in 5 eyes at different periods post-PK,and graft rejection occurred in 4 *** total OSS decreased from 12.4±4.4 before allogeneic CLET to 1.4±1.51 after ***:A sequential therapy design of PK following allogeneic CLET can maintain a stable ocular surface with improved BCVA despite the relatively high graft rejection rate.

关键词： limbal stem cell deficiency allogeneic cultured limbal epithelial transplantation penetrating keratoplasty graft rejection

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Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating keratoconus

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2013年第5期14卷 438-450页

作者： Yong-ming ZHANG Shuang-qing WU Yu-feng YAO Department of Ophthalmology Sir Run Run Shaw HospitalSchool of MedicineZhejiang University Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University

Objective: To compare postoperative outcomes of full-bed deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in treating keratoconus. Methods: Seventy-five eyes of 64 patients who received full-bed DALK and 52 eyes of 51 patients who received PK between June 2000 and August 2010 were included in this retrospective study. Full-bed DALK was performed using Yao's hooking-detaching technique. PK was performed using a standard technique. Intraoperative and postoperative complications, visual acuity, rejection, graft survival, endothelial cell density, corneal sensation recovery, and re-innervation were compared between the two groups. Results: A best correct visual acuity of 0.5 or better was achieved in 90.7% of eyes after full-bed DALK and in 92.3% of eyes after PK (P=0.75). By the fifth postoperative year, graft endothelial cell loss reached 34.6% in the PK group vs. 13.9% in the full-bed DALK group (P0.05). Intraoperative microperforation occurred in seven out of 75 (9.3%) eyes with a temporally postoperative double anterior chamber in two eyes in the full-bed DALK group. Postoperative complications in the PK vs. the full-bed DALK groups respectively were: rejection (7.7% vs. 0%, P=0.015), high intraocular pressure (IOP) (46.2% vs. 1.3%, P<0.001), secondary glaucoma (9.6% vs. 0%, P=0.006), complicated cataract (19.2% vs. 0%, P<0.001), and wound dehiscence (9.6% vs. 0%, P=0.006). Conclusions: Both full-bed DALK and PK can offer long-term satisfactory visual outcomes for keratoconus. Graft rejection, secondary glaucoma, complicated cataracts, and constant endothelial cell loss were observed in eyes only after PK.

关键词： Full-bed deep anterior lamellar keratoplasty penetrating keratoplasty Keratoconus Forceps hooking Viscoelastic detaching

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Trends in the indications for penetrating keratoplasty in Shandong,2005-2010

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International Journal of Ophthalmology(English edition) 2011年第5期4卷 492-497页

作者： Jun-Yi Wang, Jing Zhao Department of Ophthalmology Renmin Hospital of Wuhan University Wuhan 430060 Hubei Province China State Key Laboratory Cultivation Base Shandong Provincial Key Laboratory of Ophthalmology Shandong Eye Institute Shandong Academy of Medical Sciences Qingdao 266071 Shandong Province China

AIM: To identify the current indications and the trend shifts for penetrating keraboplasty (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.

关键词： penetrating keratoplasty indication infectious keratitis

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General anesthesia versus local anesthesia for penetrating keratoplasty: a prospective study

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International Journal of Ophthalmology(English edition) 2014年第2期7卷 278-282页

作者： Xu Wang Guang-Fu Dang Ying-Mei Li Wei-Fan Li Xin-Yi Wu Department of Ophthalmology Qianfoshan HospitalMedical School of Shandong University Department of Ophthalmology Jinan No.2 Hospital Department of Anesthesiology Jinan No.2 Hospital Department of Ophthalmology Qilu Hospital Medical School of Shandong University

AIM:To examine which anesthesia general or local is more effective for penetrating keratoplasty(PKP).METHODS:Patients with indications for PKP(n=141)were enrolled in a prospective study and randomly divided into general anesthesia group(group A,70 eyes)and local anesthesia group(group B,71 eyes).Patients received optical PKP(group A1,30 eyes;group B1,30eyes)or therapeutic PKP(group A2,40 eyes;group B2,41 eyes).Measurement of anterior chamber treatment time(T)for PKP patients and the ratio(R)of the area of the pupils to that of recipient graft region.T and R values,as well as perioperative and postoperative complications,were compared between groups A and B using t-test orχ***:Patients were followed for 2wk after PKP.T was(13.45±8.64)min for group A and(7.36±5.24)min for group B,a statistically significant difference(P<0.001).The R value for group A was stable during the operation,while for PKP patients in group B the value initially increased then gradually decreased to normal after *** group B,extrusion of intraocular contents occurred in 5 eyes,and iridal prolapse occured in 11cases;no perioperative complications occurred in group *** rate for fungal keratitis was 13.04%in group B and 0%in group ***:Under general anesthesia,pupils remaine stable during PKP and perioperative complications are *** anesthesia gives more time to treat pathological changes in the anterior chamber and treatment success rate is higher.

关键词： penetrating keratoplasty general anesthesia local anesthesia

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Changing trends in penetrating keratoplasty indications at a tertiary eye care center in Budapest,Hungary between 2006 and 2017

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International Journal of Ophthalmology(English edition) 2020年第11期13卷 1814-1819页

作者： Milan Tamas Pluzsik Gabor Toth Jeannette Toth Andrds Matolcsy Achim Langenbucher Agnes Kerenyi Zoltdn Zsolt Nagy Nora Szentmary Department of Ophthalmology Semmelweis UniversityBudapest 1085Hungary Department of Ophthalmology Bajcsy-Zsilinszky HospitalBudapest 1106.Hungary 2^(nd)Department of Pathology Semmelweis UniversityBudapest 1091Hungary 1^(st)Department of Pathology and Experimental Cancer Research Semmelweis UniversityBudapest 1085Hungary Experimental Ophthalmology Saarland UniversityHomburg/Saar 66421Germany Dr.Rolf M.Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research Saarland University Homburg/Saar 66424Germany

AIM:To analyze the changing trends in penetrating keratoplasty(PKP)***:This retrospective study included all patients with PKP between 2006 and *** were classified using histological *** groups were as the following:pseudophakic or aphakic bullous keratopathy,regraft,acute necrotizing and ulcerative keratitis,keratoconus,Fuchs'dystrophy,corneal dystrophy other than Fuchs',corneal scar,other diagnoses and failed endothelial keratoplasty ***,two different time-periods(2006-2012 and 2013-2017)were ***:Totally 1721 histological analyses of 1214 patients were available for *** diagnoses were pseudophakic or aphakic bullous keratopathy in 487(28.3%),regraft in 443(25.7%),acute necrotizing and ulcerative keratitis in 313(18.2%),corneal scar in 153(8.9%),keratoconus in 140(8.1%).Fuchs'dystrophy in 61(3.5%),corneal dystrophy other than Fuchs'in 46(2.7%),other diagnoses in 44(2.6%)and failed endothelial keratoplasty graft in 34(2.0%)*** the first to the second analysed time-period,incidence of acute necrotizing and ulcerative keratitis,corneal scar,Fuchs'dystrophy increased(P<0.032 for all)and incidence of keratoconus significantly decreased(P=0.015).CONCLUSION:Pseudophakic or aphakic bullous keratopathy is the leading indication for PKP,followed by regraft and acute necrotizing and ulcerative keratitis.

关键词： penetrating keratoplasty indications histology

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Effects of immunosuppressants after penetrating keratoplasty:meta-analysis of randomized controlled trials

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International Journal of Ophthalmology(English edition) 2011年第5期4卷 529-536页

作者： Xin Wei Xiao-Ming Chen Lin Wang Jin-Ping Song and Yin-Ping Deng Department of Ophthalmology & Ophthalmic Laboratories West China Hospital Sichuan University Chengdu 610041 Sichuan Province China

AIM: To assess the effectiveness of immunosuppressants in the prophylaxis of corneal allograft rejection after high-risk keratoplasty and normal-risk keratoplasty. METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CNKI, VIP and reference lists of articles. Date of most recent search: 18 June, 2011. All randomised controlled trials (RCTs) assessing the use of immunosupressants in the prevention of graft rejection, irrespective of publication language. Two authors assessed trial quality and extracted data independently. Only dichotomous outcomes (clear graft survival, ratio of immune reactions and side effects) were available and were expressed as relative risk (RR) and 95% confidence intervals (CI). RESULTS: Seven studies were included in this review. In the comparing of mycophenolate mofetil (MMF) with placebo, the results showed MMF could significantly reduce immune reactions compared with placebo (RR 1.08 95% Cl 0.95 to 1.21), but no effect on clear graft survival (RR 1.11 95% Cl 0.90 to 1.35). In clear graft survival and immune reactions, MMF and cyclosporine A (CsA) showed similar effect (RR 1.11 95% Cl 0.90 to 1.35, and RR 1.48, 95% Cl 0.56 to 3.93, respectively). Tacrolimus (FK506) and steroid showed similar effects on clear graft survival and immune reactions (RR 0.32, 95% CI 0.02 to 6.21, and RR 1.00, 95%CI 0.88 to 1.14, respectively). No drug relative side effect has been found. CONCLUSION: MMF may reduce immune reactions in both normal-risk and high-risk rejection of penetrating keratoplasty. CsA and FK506 showed similar effects as MMF. However, due to the lack of large clinical trials, the evidence remain weak, the quality of evidences were rated as very low to moderate. Large, properly randomised, placebo-controlled, double masked trials are needed to evaluate the effect of immunosuppressants.

关键词： immunosuppressants penetrating keratoplasty meta-analysis

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Black diaphragm intraocular lens implantation and penetrating keratoplasty in aphakic eyes with traumatic aniridia

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International Journal of Ophthalmology(English edition) 2013年第2期6卷 183-186页

作者： Jun Li Xiao-Guang Dong Qingdao University Medical College Shandong Eye Institute Shandong Academy of Medical Sciences

AIM:To evaluate the long-term outcome of implantation of black diaphragm intraocular (BDI) lens combined with penetrating keratoplasty (PKP) for managing aphakic eyes with traumatic aniridia and corneal damage. METHODS: Six aphakic eyes of six patients with traumatic aniridia and corneal damage had BDI lens implantation at Qingdao Eye Hospital, Shandong Eye Institute from June 2008 to November 2011. Medical records of the patients were reviewed. Three patients received PKP and after 12-18months were implanted with BDI lens. The other three patients completed PKP and BDI lens implantation at the same time. The corrected visual acuity, intraocular pressure and number of corneal endothelial cells were monitored. RESULTS: The patients were followed up for an average of 24.3 ±12.1months (range 14-48 months). All BDI lenses were located well. The best corrected visual acuity got improved in 5 patients (0.1-1.0) and decreased in 1 patient from 0.4 to 0.2. Three patients had normal intraocular pressure (IOP) after implantation. Two patients required antiglaucoma medications to control IOP within the normal range and 1 patient implanted Ahmed glaucoma valve to control IOP. The corneal grafts kept transparent in all eyes and the corneal endothelial counting >1 000/mm2 , although two patients experienced acute graft rejection and loss more than 30% corneal endothelial ***: Implantation of BDI lens combined with PKP is an effective option for managing aphakic eyes with traumatic aniridia and corneal damage. Although the results in our study are encouraging, additional studies of the long -term safety and efficacy are required. Alarger study population and longer follow-up may be beneficial.

关键词： black diaphragm intraocular lens penetrating keratoplasty aniridia trauma

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Surgical management of spontaneous,lateonset Descemet membrane detachment after penetrating keratoplasty for keratoconus:a case report

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Eye and Vision 2017年第1期4卷 66-69页

作者： Myrsini Petrelli Konstantinos Oikonomakis Konstantinos Andreanos Andreas Mouchtouris Ilias Georgalas George Kymionis Department of Ophthalmology University of AthensAthensGreece

Background:To report a surgical method for treating corneal oedema in a case of late-onset Descemet membrane detachment after penetrating *** presentation:A 55-year old patient presented with sudden visual loss in his left eye 28 years after penetrating keratoplasty for ***-lamp biomicroscopy revealed a distortion of the corneal graft anatomy with protrusion of the graft and peripheral thinning and steepening in the residual host tissue,accompanied by corneal graft *** segment optical coherence tomography revealed detachment of Descemet membrane localized to the area of the graft *** proceeded with a full-thickness,partially circumferential incision in the graft-host junction,followed by repositioning and re-suturing of the graft in place,and intracameral air injection in order to achieve reattachment of Descemet ***:Corneal graft repositioning in combination with re-bubbling may represent an effective therapeutic option in keratoconic patients with peripheral thinning in the residual host corneal tissue and subsequent Descemet membrane detachment.

关键词： Keratoconus penetrating keratoplasty Spontaneous Descemet membrane detachment

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Indications for penetrating keratoplasty and anterior lamellar keratoplasty during 2010-2017

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International Journal of Ophthalmology(English edition) 2019年第12期12卷 1878-1884页

作者： Xiao-Tong Sun Hua-Lei Zhai Jun Cheng Qian-Qian Kong Lin Cong Lin Li Wen-Pei Hao Qingdao Eye Hospital of Shandong First Medical University Shandong Eye Institute Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base

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.

关键词： penetrating keratoplasty anterior lamellar keratoplasty indications

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Graft survival and visual outcome after simultaneous penetrating keratoplasty and cataract extraction

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International Journal of Ophthalmology(English edition) 2013年第3期6卷 385-389页

作者： Mansour M. Al-Mohaimeed Department of Ophthalmology College of Medicine Qassim University

AIM: To evaluate the indications, complications, and visual and graft survival outcomes in eyes that had undergone simultaneous cataract extraction and penetrating keratoplasty (PKP). ·METHODS: We described a retrospective study of 101 patients who had undergone simultaneous cataract extraction and PKP at King Khaled Eye Specialist Hospital between January 1, 2001, and December 31, 2002. All patients were followed up postoperatively with maximum follow-up 68 months. ·RESULTS: The mean age of patients was 61 years. The mean overall follow -up was 27 months. The most common indications for surgery were corneal scarring (45.5% ), previous failed graft (15.8% ), corneal ulcer (12.9% ), Fuchs endothelial dystrophy (8.9% ), stromal dystrophy (2.9% ), and other conditions (14.5% ). Overall, 69 grafts (68.3% ) remained clear at final follow -up. Previous glaucoma or postoperative glaucoma had no statistically significant effects on graft outcome (P >0.05). The graft rejection rate (17.8% ) was a significant risk factor for failure (P =0.00). Age, gender, indications for surgery, corneal graft diameter, and intraoperative vitreous loss had no statistically significant effects on the PKP outcome (P >0.05). Postoperative visual acuity was significantly associated with preoperative visual acuity (P <0.01). ·CONCLUSION: The present study provides evidence that performing a combined procedure results in more rapid visual rehabilitation and good graft clarity.

关键词： penetrating keratoplasty cataract extraction graft failure

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