Comparison of refractive outcomes in three corneal transplantation techniques for keratoconus

Huang, Ting; Hu, Yunwei; Gui, Mengru; Hou, Chao; Zhang, Hong

doi:10.1007/s00417-015-3091-2

Cited by 19 publications

(11 citation statements)

References 24 publications

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“…In our results, the mean value for postoperative corneal topographic astigmatism was 3.59 ± 0.98 D. This was significantly smaller than the previously reported 5.0 ± 1.5 D [23]. These results may have been obtained because the IOP was kept stable, and suturing was performed under equable conditions.…”

Section: Discussioncontrasting

confidence: 79%

Stepwise Decreasing of Vitreous Pressure by Anterior Vitrectomy: A Novel Method for Preventing Positive Vitreous Pressure During Penetrating Keratoplasty

et al. 2019

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Background: This study evaluates the clinical effects of the stepwise anterior vitrectomy on the prevention of positive vitreous pressure (PVP) during penetrating keratoplasty (PKP). Methods: PKP in conjunction with stepwise anterior vitrectomy was performed on 15 eyes of 15 patients under retrobulbar anesthesia. A preset vitrectomy trocar-cannula was inserted into the vitreous cavity before PKP. During the opening of the anterior chamber, intermittent vitrectomy and corneal incision expansion were performed alternately to keep the lens or artificial intraocular lens (IOL) and iris flat until the entirety of the pathological cornea had been dissected. The main outcome measures include visual acuity, crystalline lens rise (CLR), corneal curvature and diopter, and corneal endothelial cell loss. Results: All surgical procedures were performed successfully without any PVP-related intraoperative complications. The mean time of the stepwise vitrectomies was 3.1 ± 0.7 s, the duration of each vitrectomy was 8.1 ± 5.3 s, and the duration of the total surgery was 60.5 ± 5.3 min. The anterior segment reaction was mild and the shape of the pupil remained normal 1 day after surgery. The mean preoperative and mean 3-month postoperative CLR values were 0.48 ± 0.09 mm and-0.16 ± 0.04 mm, respectively (p \ 0.0001). The mean preoperative endothelial cell density in donor buttons was 2570 ± 171 cells/mm 2 , and the mean 6-and 12-month postoperative endothelial cell density in donor buttons was 2207 ± 127 cells/mm 2 and 2000 ± 198 cells/ mm 2 , respectively. Conclusions: The novel and stabilized PKP procedure, performed in conjunction with the stepwise anterior vitrectomy, effectively avoided the PVP during open-sky surgery.

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Section: Discussioncontrasting

confidence: 79%

Stepwise Decreasing of Vitreous Pressure by Anterior Vitrectomy: A Novel Method for Preventing Positive Vitreous Pressure During Penetrating Keratoplasty

et al. 2019

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“…8,11 Limberg et al 15 proposed that imprecise graft-host matching might result in astigmatism of about 4 to 6 diopters. 1 Kaiserman et al 11 reported slight misalignment-associated astigmatism after PK. Jhanji et al 17 categorized the alignment patterns as step and ledge, but failed to describe the relevance of malappositions to postoperative visual outcomes.…”

Section: Discussionmentioning

confidence: 99%

Malapposition of Graft-host Interface after Penetrating Keratoplasty (PK) and Deep Anterior lamellar Keratoplasty (DALK): an optical coherence tomography study

Zhao¹,

Zhuang²,

Hong³

et al. 2020

Preprint

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Backgroud: Previous studies of internal graft-host malappositions have not dealt with the precise ways in which each malapposition affected post-penetrating keratoplasty (post-PK) visual outcomes. In this study, we reviewed our post-PK and post-deep anterior lamellar keratoplasty (post-DALK) keratoconic patients and used anterior segment optical coherence tomography (AS-OCT) to evaluate the associations between graft-host interface (GHI) characteristics and visual outcomes. Methods: Novel GHI metrics included: mean graft-host touch (GHT), total prevalence of malapposition proportion (Pm), frequency of apposition (F), size of malapposition (Sm), junctional graft thickness (Tg), junctional host thickness (Th) and the absolute value of difference between Tg and Th (|Tg-Th|). We connected the external and internal junction points of GHI (GHT) and drew a straight line through the central point, perpendicular to both sides of the cornea. Tg and Th were the thicknesses at cross-points 1 mm away from the meeting point on the external side of the graft and host, respectively. Linear regression analysis was used to describe associations between GHI metrics and postsurgical visual outcomes [ logarithm of minimum angle of resolution best-corrected visual acuity (logMAR BCVA), spherical equivalent diopter (SE), diopter of spherical power (DS), diopter of cylindrical power (DC) and keratometric astigmatism (Astig value)]. Results: We enrolled 22 post-PK and 23 post-DALK keratoconic patients. Compared with the regular-apposition results, GHT was decreased in step and gape patterns, and increased in hill and tag patterns. SE increased averagely by 6.851, 5.428 and 5.164 diopter per 1% increase in: F (step) [β=6.851; 95% Confidence interval (CI)=2.975-10.727; P=0.001]; F (graft step) [β=5.428; 95% CI=1.685-9.171; P=0.005]; and Pm [β=5.164; 95%CI=0.913-9.146; P=0.018], respectively. SE increased averagely by 0.31 diopter per 10-μm increment in |Tg-Th| [β=0.031; 95% CI=0.009-0.054; P=0.007]. LogMAR BCVA increased (on average) by 0.01 per 10-μm increment in both GHT [β=0.001; 95% CI=0-0.002; P=0.030]. and Tg [β=0.001; 95% CI=0.001-0.002; P=0.001]. Astig value increased on average by 0.17 diopter per 10-μm increment in Sm [β=0.017; 95% CI=0-0.033; P=0.047]. Conclusion: This investigation of GHI characteristics suggests explanations for varied ametropia in keratoconic eyes and has potential significance as a reference for promoting pre-surgical planning and technology for corneal transplantation.

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“…In previous studies, some scholars thought that DALK surgery should be performed in the formative stage of keratoconus, as the penetration of the corneal elastic layer in the acute edema stage would result in a decrease in the number of endothelial cells and would not be suitable for the choice of the procedure. [18] The patients in this study were in the formative stage of keratoconus. The postoperative examination after DALK surgery showed that ECD might be lower than the normal requirements of ICL surgery after examination by cytometry within a certain period of time after DALK surgery.…”

Section: Discussionmentioning

confidence: 99%

Clinical application of TICL implantation for ametropia following deep anterior lamellar keratoplasty for keratoconus

Qin

Yang

et al. 2017

Medicine

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Background:This study aimed to investigate the clinical application of phakic toric intraocular collamer lens (TICL) implantation in treating ametropia following deep anterior lamellar keratoplasty (DALK) for patients with keratoconus, especially the effectiveness and safety of high astigmatism and indications of TICL implantation after corneal transplantation.Methods:Using the self-controlled case series observation approach, 9 patients with ametropia (9 eyes) who underwent DALK surgery for keratoconus 1.5 years ago with stitches removed 3 months ago were kept under observation from May 2013 to April 2014 in Ophthalmic Center of Nanjing Drum Tower Hospital affiliated to Nanjing Medical University. TICL implantation was performed in all patients. The uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) were examined before surgery and 1 week, 6 months, 1 year, and 2 years after surgery. Corneal astigmatism, corneal thickness, anterior chamber depth, corneal endothelial cell density (ECD), and preoperative and postoperative intraocular pressures at different time points were measured. Intraoperative or postoperative complications of TICL implantation were observed, and the safety of the operation was evaluated.Results:The UCVA and BCVA in all operated eyes were better 6 months after surgery than before surgery. The spherical diopter and cylindrical diopter decreased to different degrees after surgery. Six months after surgery, the deviation of TICL axis in all operated eyes was less than 10 degrees, tending to be stable. No severe intraoperative or postoperative complication occurred.Conclusion:TICL implantation was an optional choice for ametropia correction after DALK surgery, especially in patients with high astigmatism.

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Comparison of refractive outcomes in three corneal transplantation techniques for keratoconus

Abstract: Although DALK has a slightly higher degree of myopic refraction than PK, DALK and PK have comparable visual acuity outcomes and similar methods of vision correction. DALK is recommended for the treatment of keratoconus.

Cited by 19 publications

References 24 publications

Stepwise Decreasing of Vitreous Pressure by Anterior Vitrectomy: A Novel Method for Preventing Positive Vitreous Pressure During Penetrating Keratoplasty

Stepwise Decreasing of Vitreous Pressure by Anterior Vitrectomy: A Novel Method for Preventing Positive Vitreous Pressure During Penetrating Keratoplasty

Malapposition of Graft-host Interface after Penetrating Keratoplasty (PK) and Deep Anterior lamellar Keratoplasty (DALK): an optical coherence tomography study

Clinical application of TICL implantation for ametropia following deep anterior lamellar keratoplasty for keratoconus

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