Corneal lamellar flap retraction after LASIK following penetrating keratoplasty

PURPOSE: To describe a case of lamellar flap retraction after laser in situ keratomileusis (LASIK) to correct myopia and astigmatism after penetrating keratoplasty (PKP). METHODS: Eleven months after PKP, a 34-year-old man underwent uneventful LASIK. Preoperative manifest refraction was -5.50 + 4.00 x 55, giving a best-corrected visual acuity (BCVA) of 20/20. Three days after LASIK, the central cornea was clear with a 1- to 2-mm displacement and marked swelling of the inferior edge of the lamellar corneal flap, without central striae. The patient's uncorrected visual acuity (UCVA) was 20/60. The flap was repositioned, sutured with 6 10-0 nylon interrupted sutures, and covered with a bandage contact lens. RESULTS: Five months after the repair, the cornea was clear, UCVA was 20/400, and manifest refraction was -9.50 + 6.00 x 75, giving a BCVA of 20/60. Three years later, manifest refraction was - 9.00 + 4.00 x 70, giving a BCVA of 20/40+2. CONCLUSION: In LASIK surgery after PKP, there is a risk of flap edema leading to retraction of the transplant wound. It may therefore be advisable to wait at least 1-2 years after PKP before performing LASIK. Patients who have corneal transplants should also be warned that they might have unique risks in LASIK treatment that may result in the loss of vision.     

Corneal endothelium after deep anterior lamellar keratoplasty and penetrating keratoplasty for keratoconus: a four-year comparative study

Purpose:

To compare the status of corneal endothelium and central corneal thickness within the first four postoperative years after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) in patients with keratoconus.

Materials and Methods:

Thirty-nine eyes (Group A) which had PK and 44 eyes (Group B) which had DALK for the treatment of keratoconus were included in this retrospective study. The endothelial cell density (ECD), the mean endothelial cell area and the coefficient of variation of cell area were assessed with a non-contact specular microscope, and the central corneal thickness (CCT) was measured with an ultrasound pachymeter.

Results:

Mean ECD loss rate at two years was 36.24% in Group A and 18.12% in Group B (P<0.001). Mean ECD loss rate at four years was 47.82% in Group A and 21.62% in Group B (P<0.001). Mean annual ECD loss rate was calculated 14.12% per year in Group A and 5.78% per year in Group B. In the PK group, increase in mean CCT was 15.60% in two years and 15.03% in four years, while in the DALK group, mean CCT increased by 8.05% in two years and 9.31% in four years.

Conclusions:

As the majority of ectatic disorders such as keratoconus occur in young people, long-term endothelial cell survival following treatment with keratoplasty is essential for the long-term visual ability. Our finding that corneal endothelial cell loss in the DALK group occurs at a slower rate than in the PK group suggests DALK as a safer alternative to PK in these selected patients.     

Outcomes of deep anterior lamellar keratoplasty versus intralase enabled penetrating keratoplasty in keratoconus

Objective

To compare the visual and refractive outcomes after deep anterior lamellar keratoplasty (DALK) and intralase enabled keratoplasty (IEK) for keratoconus.

Design

A retrospective comparative case series.

Participants

Eighteen eyes that underwent DALK and 18 that had IEK for keratoconus.

Methods

Main outcome measures included preoperative and postoperative best spectacle corrected visual acuity (BSCVA), refraction, high-order aberrations (HOA), and complication rate were compared between the 2 groups after all suture removals.

Results

Mean time to all suture removal was 11.91 months for the DALK and 6.7 months for the IEK. The mean logMAR BSCVA of patients in the DALK group was 0.28 (20/38) and 0.37 (20/46) in the IEK group (p < 0.211). The final sphere was −5.62 and −0.53 in the DALK and IEK groups, respectively (p < 0.973). There was statistically significant difference in the astigmatism between the 2 groups with mean manifest cylinder of 3.13 in the DALK group and 5.78 in the IEK group (p < 0.011).Total HOA (DALK 6.11 vs IEK 9.32, p < 0.036) and total spherical aberrations (DALK 0.44 vs IEK 0.71, p < 0.041) were both significantly higher in the IEK group. A total of 44.4% of eyes underwent astigmatic keratotomy after IEK compared to 5.6% of eyes in the DALK group (p < 0.018; odds ratio = 13.6 [1.48, 125.31]). Overall complication rates were similar for DALK and IEK groups.

Conclusions

BSCVA and complication rates are similar after DALK and IEK, but each technique has its advantage. IEK offered shorter time to suture removal whereas DALK offered lower postoperative astigmatism and HOA rates.     

Deep anterior lamellar keratoplasty versus penetrating keratoplasty in the treatment of stromal corneal dystrophies

AIM: To compare the efficacy and safety of penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) in the treatment of stromal corneal dystrophy.METHODS: A systematic review and Meta-analysis was conducted for studies comparing visual acuity [best-corrected visual acuity (BCVA) (LogMAR)] and corneal endothelial cell count (ECC) as well as safety outcomes of DALK and PK surgeries, including graft-related outcomes and intraoperative and postoperative complications. Embase, PubMed, and Google Scholar were searched for eligible studies until June 2019. Continuous and dichotomous variables were expressed as weighted mean difference (WMD) and risk ratios (RRs), respectively, along with their respective 95% confidence intervals (CIs).RESULTS: Five comparative studies recruiting 350 patients with macular and/or lattice corneal dystrophy (59.71% males) were eventually included. No significant differences were noted in the mean BCVA after both types of surgeries. However, following DALK procedures, corneal ECC was significantly higher two years postoperatively (WMD=401.62 cell/mm2, 95%CI: 285.39-517.85, P<0.001), and graft and endothelial rejection rates were significantly lower (RR=0.30, 95%CI: 0.14-0.64, P=0.002; RR=0.09, 95%CI: 0.02-0.46, P=0.004, respectively) when compared to patients undergoing PK procedures. However, DALK procedures were associated with increased risks of intraoperative Descemet’s membrane perforations and postoperative double anterior chamber (All P<0.001).CONCLUSION: DALK procedures are relatively more efficacious over the follow up periods with better safety outcomes than PK in patients with stromal CDs, conerning rejection and better visual outcome.     

深板层角膜移植与穿透性角膜移植治疗基质性角膜营养不良

目的：比较深板层角膜移植(DALK)与穿透性角膜移植(PK)治疗基质性角膜营养不良的有效性和安全性。

方法：系统回顾性Meta分析。对比较视力\〖最佳矫正视力(BCVA)(LogMAR)\〗和角膜内皮细胞计数(ECC)以及DALK和PK手术的安全性结果,包括移植物相关结果和术中术后并发症。直到2019-06,使用Embase、PubMed和Google Scholar搜索符合条件的研究。

结果：最终纳入了350例黄斑点状CD患者(男性59.71%)的五项对比研究。两种手术后的平均BCVA无明显差异。然而,经过DALK手术,术后两年角膜ECC明显升高(WMD=401.62 cell/mm², 95% CI： 285.39-517.85, P<0.001),与接受PK手术的患者相比,移植物和内皮细胞排斥反应率显著降低(RR=0.30, 95% CI： 0.14-0.64, P=0.002; RR=0.09, 95% CI： 0.02-0.46, P=0.004)。但是,DALK手术增加了术中后弹力膜穿孔和术后双前房的风险(P<0.001)。

结论：对于间质性CDs患者,DALK治疗在随访期间相对更有效,更安全,减少排斥反应,提高视觉效果。     

Deep lamellar keratoplasty versus penetrating keratoplasty for corneal lesions

PURPOSE: To compare the effectiveness of deep lamellar keratoplasty (DLK) with that of penetrating keratoplasty (PKP) in cases of corneal lesions not involving the endothelium. METHODS: Forty-eight eyes with leukomatous corneal opacity (n = 33), keratoconus with apical scarring (n = 6), granular corneal dystrophy (n = 5), lattice corneal dystrophy (n = 2), and multiple corneal foreign bodies (n = 2) in an age group varying from 16 to 53 years underwent DLK (n = 24) and PKP (n = 24) by utilizing B and (B+ and A) grade M-K preserved donor tissue, respectively. The patients were followed up closely, and the graft clarity, visual achievement, astigmatism and endothelial cell count were evaluated at repeated occasions up to 1 year. RESULTS: Astigmatism of <3 diopters (D) and > or = 5D was obtained in 19 eyes and one eye, respectively, after DLK at 6 months, whereas six eyes of the PKP group had astigmatism <3D, and 12 eyes had > or = 5D at the end of 6 months. The same at 1 year was observed in 20 and one eye in the DLK and eight and five eyes of the PKP group. Astigmatism of > or = 5D at the end of 6 months in both the groups showed highly significant changes (p < 0.001). Best corrected visual acuity of 6/18 or more was achieved in 18 and 12 eyes at 6 months after DLK and PKP, respectively, which were statistically highly significant (p < 0.001), whereas at 1 year, it was seen in 17 and 15 eyes of the DLK and PKP groups, respectively, which was nonsignificant. The mean endothelial cell count was 2,233.3+/-64.453 cells/mm2 and 2,219.6+/-102.48 cells/mm2 at 6 months and I year, respectively, after DLK, which was nonsignificant. The mean cell count of the donor eyes used for PKP was 2,191+/-52.164 cells/mm2, 1,902.8+/-70.346 cells/mm2 at 6 months, and 1,579.0+/-80.24 cells/mm2 at 1 year. All the values showed highly significant changes (p < 0.001). Further, the graft clarity of > or = 3+ was achieved in 20 and 18 eyes at 6 months postoperatively in the DLK and PKP groups, whereas the same was observed in 19 and 13 eyes of both the groups, respectively, at 1-year follow-up. CONCLUSION: DLK is a promising procedure and should be practiced more frequently for corneal pathology not involving the endothelium.     

Comparison of refractive changes after deep anterior lamellar keratoplasty and penetrating keratoplasty for keratoconus

Purpose  

To compare refractive changes occurring after deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PKP) in patients with keratoconus.     

穿透性角膜移植术后植片松线重缝的临床研究

目的 探讨穿透性角膜移植术(penetrating keratoplasty,PKP)后因松线而进行植片重缝的时间及不同原发病的差异、手术前后角膜散光的变化.方法 对2004年1月至2006年6月我院PKP术后行植片重缝的41例(41眼)患者进行随访,其中男28例(28眼)、女13例(13眼);统计PKP术后行松线重缝的原发病、时间及散光变化.结果 松线重缝时间发生于术后1～4个月,感染性角膜病组(真菌性角膜炎、单纯疱疹性病毒性角膜炎、细菌性角膜炎)多发生于术后1个月内,平均为术后(24±10)d.非感染性角膜病组(圆锥角膜、粘连性角膜白斑、Fuchs角膜内皮营养不良、碱烧伤)多发生于术后3个月内,平均为术后(68±36)d.重缝后植片回复平整,上皮愈合.角膜散光平均减少3.74 D.结论 PKP术后3个月内植片重缝可以防止植片翘起,显著降低角膜散光.     

Corneal wound dehiscence after penetrating keratoplasty

PURPOSE: To describe the clinical features of corneal wound dehiscence after penetrating keratoplasty (PK) after trauma and suture removal. METHODS: A retrospective review of all eyes needing resuturing in the 5-year period of July 2000 to June 2005 was performed. In total, 76 eyes of 76 patients needed wound resuturing. The indications were early wound leak, wound dehiscence, broken suture, or loose suture. In 29 of the 76 cases, the indication for resuturing after PK was wound dehiscence. Of these, 19 were caused by trauma, and in 10 eyes, dehiscence shortly followed suture removal. RESULTS: The interval between original PK and traumatic wound dehiscence caused by trauma ranged from 15 days to 33 years. In 5 eyes, it was >15 years. Nine eyes (47%) with traumatic dehiscence had final visual acuity better than 6/60, whereas 8 eyes (80%) with suture removal dehiscence had final visual acuity better than 6/18. Most of the dehiscence in the traumatic group was located in the inferior 2 quadrants, in contrast to temporally in the postsuture removal group. The time interval between PK and suture removal in the postsuture removal group was 16 +/- 4 months, and 7 (70%) patients had a continuous suture. Post-suture removal dehiscence was more common when corneal edema was the indication for grafting. CONCLUSIONS: Eyes with traumatic wound dehiscence have worse visual outcome than those with dehiscence after suture removal. Patients should be cautioned about the risks and consequences of wound dehiscence. The suture may be left in place longer in older patients or when corneal edema is the indication for grafting.