Etiology and outcome of penetrating keratoplasty in bullous keratopathy post-cataract surgery vs post-glaucoma surgery

Jung, Young‐Ho; Choi, Hyuk Jin; Kim, Mee Kum; Oh, Joo Youn

doi:10.1371/journal.pone.0285419

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…Further analysis of the data showed that aphakic bullous keratopathy was present in 11% of the cases. A rare simultaneous occurrence of bullous keratopathy and cataracts was seen in 5% of cases [19]. Additionally, a prevalence rate of 5% for FED was discovered in the cohort under study.…”

Section: Discussionmentioning

confidence: 71%

A Comprehensive Investigation Into the Outcomes of Descemet’s Stripping Endothelial Keratoplasty (DSEK) as a Treatment for Corneal Endothelial Disorders

Tilak,

Dora,

Tudu

et al. 2023

Cureus

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Background and objectives: Descemet's stripping endothelial keratoplasty (DSEK) has emerged as the preferred method for posterior lamellar keratoplasty, as it enables the replacement of the compromised host endothelium with a viable donor lamella. The objective of this study was to assess the impact of DSEK on surgical outcomes and visual acuity.Methods: The research was carried out from November 2019 to October 2021, encompassing a sample of 18 patients (18 eyes) who satisfied the inclusion criteria for DSEK. The pre-operative evaluation was performed once before the surgery, while post-operative evaluations were conducted at one, three, and six months after the surgical intervention. The main variables assessed in this study encompassed demographic characteristics, visual acuity, surgical techniques, and surgical complications employed during the surgical procedure. The collected data were statistically analyzed using IBM SPSS software version 21 (IBM Corp., Armonk, NY, USA).Results: Patients in the study ranged in age from 25 to 70, with a mean age of 53.16 ± 14.19 years. The participants were 61% male and 39% female. The main reasons for DSEK use were pseudophakic bullous keratopathy (61%) and post-penetrating keratoplasty (PK) graft failure (17%). The other indications were aphakic bullous keratopathy (11%), bullous keratopathy with cataracts (5%), and Fuchs's endothelial dystrophy (5%). The study included 18 eyes: 14 eyes underwent DSEK, two underwent DSEK with smallincision cataract surgery (SICS) and posterior chamber intraocular lens (PCIOL) implantation, and two underwent DSEK with scleral-fixated FIL. A significant improvement in best-corrected visual acuity (BCVA) was observed at six-month follow-up (0.73 ± 0.37 vs. 1.73 ± 0.59 logMAR pre-operatively). During donor cornea dissection, buttonholing was the main concern, occurring 11% of the time. Descemet's perforation and donor preparation thickness variations were also observed. Reverse donor unfolding, incomplete DM stripping, and donor button displacement were quickly addressed and managed. Post-operative graft failure occurred in 22% of cases, while acute graft rejection occurred in 11%. Graft dislocation, pupillary block, and secondary glaucoma each had a 5% prevalence.Conclusion: Descemet's stripping endothelial keratoplasty is a safe and effective treatment for corneal endothelial disorders, particularly in cases where scarring is not present. Surgical skills are essential to achieving the desired results. Descemet's stripping endothelial keratoplasty is favored over conventional keratoplasty for endothelial dysfunction due to its technical advantages and manageable risks. Our research demonstrates a significant improvement in visual acuity through DSEK. Despite manageable post-operative complications, it is vital to educate patients and medical professionals on surgical complexities. Descemet's stripping endothelial keratoplasty appears promising for the treatment of endothelial disorders, but its longterm implications must be studied.

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Section: Discussionmentioning

confidence: 71%

A Comprehensive Investigation Into the Outcomes of Descemet’s Stripping Endothelial Keratoplasty (DSEK) as a Treatment for Corneal Endothelial Disorders

Tilak,

Dora,

Tudu

et al. 2023

Cureus

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“…The preferred treatment for PBK in recent years has been EK, which permits selective replacement of the host endothelium rather than PK [6]. Studies on the effectiveness of PK [7] and EK [6,8] after BK have been previously conducted. However, studies comparing the surgical results of PK and EK in PBK are lim- [9][10][11].…”

Section: Discussionmentioning

confidence: 99%

Descemet membrane endothelial keratoplasty and penetrating keratoplasty in pseudophakic bullous keratopathy: comparison of visual outcomes, graft survival rates, and complications

Tüfekçi Balıkçı,

Demir,

Burcu

et al. 2024

The European Research Journal

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Objective: To compare the outcomes of Descemet Membrane Endothelial Keratoplasty (DMEK) and Penetrating Keratoplasty (PK) in patients with pseudophakic bullous keratopathy (PBK). Methods: Records of 51 eyes of 51 PBK patients (32 male, 19 female) who underwent PK (Group1=38 eyes) and DMEK (Group 2=13 eyes) were reviewed retrospectively. The two groups were compared for Best-corrected visual acuity (BCVA), graft survival rates, and complications. Results: The mean age was 69.1 and 67.1 years in group 1 and group 2, respectively. First-year cumulative survival rates for group 1 and group 2 were 92.1% and 61.5%, respectively, and 89.1% and 51.3% in the second year (P=0.001 by log-rank test). At the last follow-up visit, 2.7% of Group 1 and 30.8% of Group 2 had a BCVA of 0.3 or better (P=0.004). Graft failure was observed in 12 eyes (31.6%) in group 1 and 8 eyes (61.5%) in group 2 (P=0.056). At the last examination, the rates of transparent grafts were 73.7% and 69.2% in group 1 and group 2, respectively (P=0.756). Postoperative glaucoma was observed in 4 eyes (30.8%) in the group 2 and 4 eyes (10.5%) in the group 1 (P=0.083). There was no significant difference between the two groups regarding other complications (P>0.05). Conclusions: DMEK surgery offers a better visual outcome than PK for the treatment of PBK. Careful follow-up of patients is required in terms of glaucoma and graft failure after DMEK. Although the graft survival rate was lower in the DMEK group, a similar rate of graft transparency was achieved at the final examination with repeated DMEK surgery.

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“…With advancing age and a further decrease in endothelial cell density, these eyes may develop significant endothelial dysfunction and consequently pseudophakic bullous keratopathy later in life. [ 3 ]…”

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confidence: 99%

Air bubble guide for adequacy of ophthalmic viscosurgical device during phacoemulsification

Nath,

Odayappan,

Tripathy

et al. 2024

Indian Journal of Ophthalmology

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Phacoemulsification in hard cataracts is a challenge. The use of dispersive ophthalmic viscosurgical devices (OVDs) to protect the endothelium is a routine step in such scenarios. However, as OVD is transparent, it is difficult to spot within the anterior chamber. Therefore, surgeons may not be aware when the OVD coating of the endothelium disappears during surgery. Consequently, there may be too frequent OVD injections, resulting in a waste of resources. On the contrary, the surgeon may fail to inject OVD at an appropriate time, leading to greater endothelial damage. We propose a novel technique of using an air bubble as a guide that helps in identifying the time when OVD disappears from the anterior chamber, thereby suggesting the surgeon to reinject before proceeding further.

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Etiology and outcome of penetrating keratoplasty in bullous keratopathy post-cataract surgery vs post-glaucoma surgery

Cited by 4 publications

References 21 publications

A Comprehensive Investigation Into the Outcomes of Descemet’s Stripping Endothelial Keratoplasty (DSEK) as a Treatment for Corneal Endothelial Disorders

A Comprehensive Investigation Into the Outcomes of Descemet’s Stripping Endothelial Keratoplasty (DSEK) as a Treatment for Corneal Endothelial Disorders

Descemet membrane endothelial keratoplasty and penetrating keratoplasty in pseudophakic bullous keratopathy: comparison of visual outcomes, graft survival rates, and complications

Air bubble guide for adequacy of ophthalmic viscosurgical device during phacoemulsification

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