Indications for penetrating keratoplasty in a tertiary referral centre in Canada, 1996-2004

BACKGROUND: The leading indications for penetrating keratoplasty (PKP) have changed over recent years. This study examined the leading indications for PKP and their trends, comparing these with recently published data from other studies, including a report from our centre examining indications from 1986 through 1995. METHODS: A retrospective chart review was conducted of all patients who underwent PKP in a single practice at the University Health Network, Toronto Western Hospital, between July 1, 1996, and June 30, 2004. RESULTS: A total of 617 patients underwent 794 PKP operations during the 8-year study period. Sufficient documentation was available to include 777 surgeries from 600 patients in this study. Specific indications for PKP were reported and grouped into 16 categories. The leading indication categories for PKP were regraft (209 cases, 26.9%), pseudophakic bullous keratopathy (PBK) (193 cases, 24.8%), primary corneal endotheliopathies including Fuchs' endothelial dystrophy (101 cases, 13.0%), anterior keratoconus (93 cases, 12.0%), and viral or postviral causes (41 cases, 5.3%). Regraft, keratoconus, and Fuchs' endothelial dystrophy each displayed a nonsignificant decreasing trend from 1996 to 2004, and PBK, herpes simplex virus, and mechanical trauma each displayed a nonsignificant increasing trend (p > 0.05 for all). INTERPRETATION: Regraft was the leading indication for PKP at our centre, followed by PBK; these findings were in agreement with data reported in recent literature. The frequency of regraft had increased since a previous study from our centre (1986-1995), and the frequency of PBK had decreased.     

Endophthalmitis following penetrating keratoplasty

To determine the incidence of infectious endophthalmitis in the early postoperative period following penetrating keratoplasty, and the type and origin of the causative organisms, all cases of penetrating keratoplasty performed at the Emory University affiliated hospitals between January 1977 and March 1982 were reviewed. Four (0.2%) of the 1,876 cases developed infectious endophthalmitis. In all four, evidence of infection developed within 72 hours, and in three the donor rim culture grew the same organism as was obtained from the anterior chamber or vitreous. The causative organisms were Streptococcus pneumoniae, Staphylococcus aureus, group D Streptococcus-enterococcus, and Pseudomonas aeruginosa. Eyes with positive donor rim cultures had a 22-fold increased incidence of endophthalmitis.     

马来西亚西部穿透性角膜移植术的适应证

目的:探讨马来西亚穿透性角膜移植术的适应证,并将其最主要的适应证和其它国家近期出版的数据相比较。方法:对1991/2005年15a期间在马来西亚吉隆坡马来亚大学医学中心接受穿透性角膜移植术的所有患者的医学资料进行回顾性研究。患者的性别、年龄、种族、术眼及手术适应证被纳入研究分析的范围。结果:共有105例(125眼)进行了穿透性角膜移植术的患者(男71例,女34例;中国人55例,印度人33例,马来西亚人17例;单眼85只,双眼20只)纳入本次研究。患者平均年龄51.3(13～79)a。穿透性角膜移植术的适应证由主到次分别为:人工晶状体植入术后大泡性角膜病变(28.8%),角膜疤痕(20.0%),圆锥角膜(17.6%),再移植(9.6%),角膜营养不良(8.8%),角膜穿孔(7.2%)。结论:在马来西亚穿透性角膜移植术最常见的适应证是人工晶状体植入术后大泡性角膜病变。在我们的研究中,穿透性角膜移植术的三大适应证是人工晶状体植入术后大泡性角膜病变、角膜疤痕和圆锥角膜,这与世界上很多国家都是类似的,但与一些国家适应证的发生率排序不同。     

Indications for penetrating keratoplasty in west Malaysia

AIM: To determine the indications for penetrating keratoplasty in Malaysia and to compare the leading indications with recently published data from other countries. · METHODS: A retrospective review of the medical records of all patients who underwent penetrating keratoplasty at Medical Centre, University of Malaya, Kuala Lumpur, Malaysia over a period of fifteen years (1991/2005) was done. The gender, age, race of patients, eye operated, indication for surgery were noted from the records, and analyzed. · RESULTS: A total of 125 penetrating keratoplasties were performed in 105 patients (male 71 and female 34; Chinese 55, Indians 33, and Malays 17; unilateral 85 and bilateral 20) during the study period. The mean age of patients was 51.3 years (range 13-79 years). The indications for penetrating keratoplasty were pseudophakic bullous keratopathy (28.8%), corneal scar (20.0%), keratoconus (17.6%), regrafts (9.6%), corneal dystrophies (8.8%) and corneal perforations (7.2%). · CONCLUSION: Pseudophakic bullous keratopathy is the most common indication for penetrating keratoplasty in Malaysia. The three leading indications (pseudophakic bullous keratopathy, corneal scar and keratoconus) in our study are similar to many countries in the world, but they differ in the order of frequency from some countries.     

小梁切除术与Ahmed植入术治疗穿透性角膜移植术后继发青光眼的疗效比较

目的 探讨小梁切除(TRA)术与Ahmed 阀(AGV)植入术治疗穿透性角膜移植术后继发青光眼(post-penetrating keratoplasty glaucoma,PKG)的临床疗效与角膜植片安全性.方法 回顾分析我院2015 年4 月至2018年4 月PKG患者47例47 眼,按手术方式分TRA组与AGV组...     

Comparison of biomechanical parameters in penetrating keratoplasty and normal eyes using the Ocular Response Analyser

Background: To compare corneal hysteresis (CH) and corneal resistance factor (CRF) in eyes 1 year following penetrating keratoplasty (PK) with that of normal eyes using the Ocular Response Analyser. Methods: Prospective case comparison of 166 normal right eyes and 34 unilateral post‐PK eyes presenting to a teaching hospital in Birmingham, UK. The CH, CRF and Goldmann‐correlated intraocular pressure, of each eye was measured using the Ocular Response Analyser. The central corneal thickness (CCT) was measured using an ultrasonic pachymeter. Results: The mean CH was 10.6 ±2.0 mmHg, standard deviation (SD) and CRF was 10.2 ± 2.0 mmHg (SD) in normal eyes and 8.9 ± 3.3 mmHg and 8.1 ± 3.3 mmHg in post‐PK eyes, respectively. The mean CCT was 541.8 ± 36.1 µm in normal eyes and 556.0 ±69.2 µm in post‐PK eyes. The Goldmann‐correlated intraocular pressure was 16.1 ± 3.1 mmHg and 12.4 ± 2.9 mmHg in normal eyes and post‐PK eyes, respectively. The CCT was found to be higher in post‐PK eyes compared with normal eyes but the difference was not statistically significant (P > 0.5). Conclusion: Reduced biomechanical measures were found in post‐PK eyes despite a higher mean CCT. This may be due to the altered corneal structure following PK.     

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

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.     

角膜内皮移植治疗穿透性角膜移植术后植片失代偿的长期疗效观察

目的 观察角膜内皮移植手术（EK）治疗穿透性角膜移植术（PKP）后植片失代偿的长期临床效果。设计 回顾性病例系列。 研究对象 选取2008至2010年爱尔眼科医院收治的接受PKP术后植片内皮失代偿的患者6例（6眼）。 方法 对上述患者实施EK手术,对患者的临床资料进行回顾性分析。记录并分析患者术后视力、眼压、内皮细胞密度、排斥反应及并发症等。平均随访时间为（36.17±10.11）个月。主要指标  视力、眼压、内皮细胞密度、排斥反应及并发症。结果 术后所有患者植片均恢复透明,视力较前有不同程度提高,症状缓解。末次随访时,1例患者角膜失代偿,其余5例内皮细胞密度从986~1914个/mm2。随访期内,1例术后1天发生植片半脱位,经再次前房注气后贴附良好;1例术后5个月发生免疫排斥反应,经药物治疗植片保持透明;另1例患者未规律随诊,内皮移植术后26个月时发生排斥反应,导致失代偿。结论 对于反复发生免疫排斥反应导致植片混浊的高危患者,角膜内皮移植手术是可供选择的治疗方法。     

复杂性角膜穿孔伤角膜移植手术对植片内皮细胞的观察研究

目的探讨复杂性角膜外伤后穿透性角膜移植手术角膜植片内皮细胞的变化。方法用角膜内皮显微镜对穿透性角膜移植联合手术12例（12眼）的术后移植片行内皮细胞摄像分析,并用超声角膜测厚仪测量术前供体角膜及术后移植片厚度。结果穿透角膜移植术后远期角膜内皮丧失率为34．98％,平均细胞面积明显增大,变异系数也明显增大,六角形细胞比例下降,但植片的厚度在正常范围内。其中11例移植片保持透明,表明多数未发生内皮细胞功能失代偿。结论穿透性角膜移植在严格掌握适应证的情况下是一种安全的方法,虽然移植片内皮细胞各种指标变化较大,但其厚度正常,透明成功率较高,所以穿透角膜移植联合手术仍不失为治疗复杂性角膜穿孔伤的良好办法。     

穿透性角膜移植150例的临床研究

目的：探讨穿透性角膜移植的主要病因、疗效及并发症。 方法：回顾性分析2011-01/2013-06于我院行穿透性角膜移植术的患者150例150眼。 结果：病因：角膜白斑99眼（66%）,角膜变性18眼（12%）,角膜溃疡15眼（10%）,角膜内皮失代偿10眼（6.7%）,圆锥角膜8眼（5.3%）。疗效：植片透明110例（73.3%）。视力≤0.05者42例（28%）,0.05〈视力≤0.3者60例（40%）,视力〉0.3者48例（32%）。并发症：主要并发症为免疫排斥反应28例（18.7%）。 结论：穿透性角膜移植是治疗角膜疾病致盲的重要有效手段,但术后排斥反应仍是影响手术成功的主要因素。     

不同种族角膜植片对穿透性角膜移植术效果的影响

目的 通过观察不同种族间穿透性角膜移植手术的效果,总结不同种族之间穿透性角膜移植的可行性。设计 回顾性病例系列。研究对象 北京同仁眼科中心2002年10月至2003年3月因角膜白斑、角膜内皮失代偿、角膜移植术后植片失败等接受穿透性角膜移植术患者10例（10眼）。方法 采用国际组织库提供的中期保存角膜植片进行穿透性角膜移植术,其中高加索人种角膜8片,西班牙人种1片,非洲人种1片。术前收集患者资料,术后进行随访和临床观察,评价角膜植片的存活情况以及疗效。主要指标 视力,角膜植片透明度,角膜新生血管分级。结果 10例患者平均随访（12.6±3.86）个月,4例患者角膜植片基本保持透明,视力平均提高1~2行。6例（60%）患者出现植片混浊、植片水肿、新生血管长入等排斥反应,视力不提高。结论 本文小样本观察显示不同种族角膜供体可以用于穿透性角膜移植治疗。（眼科, 2013, 22:98-100）     

穿透性角膜移植50例的临床研究

目的:探讨穿透性角膜移植的疗效和相关并发症。方法:对50例(50眼)穿透性角膜移植进行回顾性分析。结果:统计分析表明:角膜植片透明者45例(90%),视力≤0.04者6例(12%),0.05～0.2者27例(54%),≥0.3者17例(34%)。主要并发症:角膜植片免疫排斥反应6例(12%),继发性青光眼4例(8%)。结论:穿透性角膜移植是提高角膜盲视力的有效手段,应重视防治术后免疫排斥反应。     

Effect of corneal graft diameter on therapeutic penetrating keratoplasty for fungal keratitis

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.     

穿透性角膜移植43例临床分析

目的:探讨穿透性角膜移植的疗效。方法:对43例43眼穿透性角膜移植进行回顾性分析。结果:统计分析表明,角膜植片透明者34例(79%),视力≥0.05者37例(86%),≥0.3者16例(37%)。发生角膜植片免疫排斥反应3例(7%),继发性青光眼1例(2%)。结论:穿透性角膜移植是部分提高角膜病患者视力的有效手段,角膜植片排斥反应是影响预后的重要因素。     

角膜移植术后行白内障摘出人工晶状体植入对角膜植片的影响

目的探讨穿透性角膜移植术后白内障行白内障摘出联合人工晶状体植入术对角膜植片的影响。方法穿透性角膜移植术6个月后行白内障摘出联合人工晶状体植入术17例（17眼）,随访3～18个月,平均11个月,观察术后角膜水肿情况、角膜内皮细胞计数变化、眼压变化、免疫排斥反应和术后并发症,并进行分析。结果术后所有患眼裸眼视力≥0．3,最佳矫正视力≥0．5者8眼。术后角膜水肿3～7d内消退,角膜恢复透明。术前角膜内皮计数平均为（1547±111）个／mm2。术后3月内皮细胞数量稳定,平均为（1275±106）个／mm2,内皮细胞丧失率平均为4．92％。无其它不良反应。结论对穿透性角膜移植术后行白内障摘出联合人工晶状体植入术对角膜植片是安全的。     

Laser in-situ keratomileusis after penetrating keratoplasty

Laser in situ keratomileusis (LASIK) after penetrating keratoplasty has been used more commonly for the correction of myopia or myopic astigmatism and less so for hypermetropia or hyperopic astigmatism. The primary goal after LASIK in such cases is resolution of sufficient myopia and astigmatism to allow spectacle correction of the residual refractive error and decrease anisometropia. All sutures should be removed prior to LASIK and the interval between penetrating keratoplasty and LASIK should be a minimum of 1 year. Preoperative evaluation includes refraction, slit-lamp biomicroscopy, corneal topography, and specular microscopy. The technique of LASIK surgery after penetrating keratoplasty is similar to the standard procedure. However, many variations have been described. These include maneuvers during surgery such as augmentation with arcuate cuts on the stromal bed and topographically guided LASIK. Other variations are relaxing incisions followed by LASIK surgery and sequential treatment by LASIK, that is, raising of the flap as a first stage procedure followed by ablation if required, 4 to 6 weeks later after relifting the flap in the second stage. Improvement in both uncorrected visual acuity and spectacle-corrected visual acuity, as well as a decrease in spherical equivalent, cylinder, and anisometropia, has been reported in various studies. All grafts were clear and no occurrence of wound dehiscence has been reported. Intraoperative complications include hemorrhage, microkeratome failure, flap buttonhole, dislocation, and perforation. Postoperative complications include undercorrection, decentered ablation, and regression. Re-enhancements after LASIK following keratoplasty are possible with acceptable visual outcome.     

Comparison of long-term outcomes of trabeculectomy and risk factors for failure in eyes post penetrating keratoplasty or Descemet’s stripping endothelial keratoplasty

Purpose:To evaluate the outcomes of trabeculectomy, graft survival, and risk factors for failure in post penetrating keratoplasty (PK) and Descemet’s stripping endothelial keratoplasty (DSEK) eyes.Methods:We reviewed charts of eyes that underwent trabeculectomy for post keratoplasty glaucoma PK [25 eyes] and DSEK [14 eyes] between 1993 and 2019. The demographics, clinical features, and surgical outcomes were evaluated. Success of trabeculectomy was defined as complete when the intraocular pressure (IOP) was >5 and ≤21 mmHg without antiglaucoma medications (AGM) and qualified with AGM. Clear and compact graft was considered for graft success.Results:Median (interquartile range [IQR] preoperative IOP in post-PK eyes and post-DSEK eyes was comparable, 32 (28–38) vs. 31.5 (25–36) mmHg, P = 0.38). Median number of preoperative AGMs was comparable (P = 0.78). Median postoperative follow-up was longer in post-PK, compared with post-DSEK, 2.5 (1.3–3.3) vs. 1 (0.3–2.9) years (P = 0.05). Kaplan–Meier survival estimates for complete and qualified success of trabeculectomy at 3 years were 23.7% and 73.3%, respectively, for PK and 45.8% and 71.6%, respectively, for DSEK. Kaplan–Meier survival estimates for graft survival were 91.8% up to 3 years for PK and 100% until 2 years and 77.8% at 3 years for DSEK. Higher IOP prior to trabeculectomy was a risk factor for failure of trabeculectomy (P = 0.03) and older age was a risk factor for graft failure (P = 0.05) in PK eyes. Number of prior corneal surgeries (P = 0.05) was associated with failure of trabeculectomy and graft failure in post-DSEK eyes.Conclusion:Trabeculectomy had moderate qualified success in post-PK and DSEK eyes at 3 years. Higher pretrabeculectomy IOP and higher number of prior corneal surgeries were significantly associated with failure of trabeculectomy in PK and DSEK eyes, respectively.