Etiology of Global Corneal Blindness and Current Practices of Corneal Transplantation: A Focused Review

Mathews, Priya; Lindsley, Kristina; Aldave, Anthony J.; Akpek, Esen K.

doi:10.1097/ico.0000000000001666

Cited by 101 publications

(82 citation statements)

References 36 publications

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“…The corneal stroma, which makes up about 90% of the corneal volume, consists of highly organized extracellular matrix (ECM) interspersed with corneal stromal keratocytes (CSKs), contributing to the physical strength and optical properties of the cornea [1]. Corneal opacification, due to scarring and opacities inside the corneal stroma, is a significant cause of global blindness [2,3]. This reduces and distorts light passage, leading to decreased vision or visual loss.…”

Section: Introductionmentioning

confidence: 99%

A cellular and proteomic approach to assess proteins extracted from cryopreserved human amnion in the cultivation of corneal stromal keratocytes for stromal cell therapy

et al. 2019

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Background: Human corneal stromal keratocytes propagated in culture media supplemented with human amnion extract (AME) can correct early corneal haze in an animal model. Clinical application of cultivated keratocytes is limited by infectious disease screening before amnion products can be used in humans. It remains unclear if AME from cryopreserved versus fresh human amnion can support human keratocyte propagation, and which components of the extract promote keratocyte growth. Methods: Three placentas were collected for the preparation of fresh and cryopreserved amnion tissues followed by homogenization and protein extraction. AME protein profiles were studied using isobaric tagging for relative and absolute quantitation (iTRAQ) proteomics. Enriched gene ontology (GO) terms and functional classes were identified. Primary human keratocytes from 4 donor corneas were cultured in media supplemented with fresh AME (F-AME) or cryopreserved AME (C-AME). Cell viability, proliferation and keratocyte marker expression were examined by confocal immunofluorescence and flow cytometry. Results: AME proteomics revealed 1385 proteins with similar expression levels (between 0.5-and 2-fold) between Fand CAME , while 286 proteins were reduced (less than 0.5-fold) in CAME. Enriched GO term and biological pathway analysis showed that those proteins with comparable expression between FAME and CAME were involved in cell metabolism, epithelial-mesenchymal transition, focal adhesion, cell-extracellular matrix interaction, cell stress regulation and complement cascades. Human corneal stromal keratocytes cultured with FAME or CAME showed similar morphology and viability, while cell proliferation was mildly suppressed with CAME (P > 0.05). Expression of aldehyde dehydrogenase 3A1 (ALDH3A1) and CD34 was similar in both cultures. Conclusion: AME from cryopreserved amnion had limited influence on keratocyte culture. It is feasible to use protein extract from cryopreserved amnion to propagate human keratocytes for potential translational applications.

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Section: Introductionmentioning

confidence: 99%

A cellular and proteomic approach to assess proteins extracted from cryopreserved human amnion in the cultivation of corneal stromal keratocytes for stromal cell therapy

et al. 2019

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“…Currently, the single, most limiting factor to cure corneal blindness is the significant shortage of donor tissues, with only one cornea available for every 70 patients who are in need 3. Unlike in USA where Fuchs endothelial dystrophy is prevalent, in developing countries the leading causes of corneal blindness are infectious keratitis or trauma with anterior stromal scarring 17 18. It is important to recognise that an estimated 98% of bilateral corneal blindness occurs outside of developed countries and involves the anterior layers of the stroma 19.…”

Section: Discussionmentioning

confidence: 99%

Long-term clinical outcomes of keratoplasty using gamma-irradiated corneal lenticules

Mathews

Fogla

Samayoa³

et al. 2019

BMJ Open Ophth

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ObjectiveTo report long-term clinical outcomes of gamma-irradiated corneal lenticules in partial and full-thickness keratoplasty.Methods and AnalysisThis multicentre, retrospective case series includes 23 patients who underwent surgery at three centres (India, Guatemala, and USA) between May 2009 and March 2018. The main outcome measures were epithelialization and retention for therapeutic keratoplasty and best spectacle-corrected visual acuity (BSCVA) for optical keratoplasty.ResultsPatients were categorised according to primary aetiology requiring corneal transplantation: non-inflammatory conditions, infectious keratitis and sterile keratolysis. Nine patients with non-inflammatory conditions underwent anterior lamellar keratoplasty (n=7) and Boston type 1 keratoprosthesis (n=2). All nine grafts remained intact and epithelialized during follow-up (median 24 months). In the seven patients who underwent anterior keratoplasty, the graft stayed optically clear during follow-up (median 12 months), with BSCVA between 20/20 and 20/40 in all but one patient who developed cataract. Nine patients with severe infectious keratitis had emergency patch grafting. Six of those grafts epithelialized and remained intact over a median of 30 months, providing tectonic support until optical keratoplasty with fresh tissue could be performed. Three grafts had recurrent infectious keratitis 1–3 months postoperatively, two of which underwent tectonic keratoplasty with fresh tissue which also eventually became infected during follow-up. In five additional patients with sterile keratolysis who underwent lamellar patch graft, two grafts remained intact during follow-up (median 36 months). Two patients had recurrent corneal melt within 1 month, and both had subsequent corneal surgery with fresh tissue which also failed. There were no donor-related complications.ConclusionGamma-irradiated sterile corneal stromal lenticules can be considered as a viable alternative to fresh tissue in various clinical settings.

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“…According to the 2018 EBAA (Eye Bank Association of America) statistical report, the most common indication for any corneal transplantation in the United States is endothelial failure while keratoconus and keratitis are the most common indications in other regions. 2,3 Although corneal graft survival rates are quite high in these conditions, the survival rates in eyes with high-risk characteristics are significantly lower and in some cases so poor that traditional keratoplasty is not even indicated, underscoring the need for other forms of treatment. In addition, the scarcity of donor corneas in many regions of the world prevents traditional keratoplasty to have a significant impact on corneal blindness where the prevalence is the highest.…”

Section: Introductionmentioning

confidence: 99%

<p>Boston Type 1 Keratoprosthesis: Updated Perspectives</p>

Nonpassopon¹,

Niparugs²,

Cortina³

2020

OPTH

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The use of Boston type 1 keratoprosthesis (BKPro) has significantly increased worldwide. It is no longer considered a procedure of last resort but a reasonable option for patients with otherwise poor prognosis for a traditional penetrating keratoplasty. BKPro was approved by the Food and Drug Administration in 1992 for bilateral severe corneal blindness due to multiple corneal transplant failure. Over the years, indications have extended beyond recurrent immunologic rejection to include other conditions such as chemical injury and other causes of bilateral limbal stem cell deficiency, extensive corneal neovascularization, neurotrophic corneas and hypotony, among others. Numerous advances in the design of the BKPro, improvement of preoperative, intraoperative and postoperative management have resulted in favorable outcomes and a reduction in postoperative complications. Accordingly, many studies have shown that implantation of this device is highly effective in restoring vision with very good short-term outcomes. However, due to the lifetime risk of sight-threatening complications after BKPro implantation, a longer follow-up period should provide outcomes that are more realistic. In this review, the authors examined only the results of publications with an average of at least 2 years of follow-up. The overall intermediate to long-term visual outcomes and retention rate in BKPro seem to be favorable. However, autoimmune diseases and cicatrizing conditions continue to show a higher incidence of postoperative complications that require further management.

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Etiology of Global Corneal Blindness and Current Practices of Corneal Transplantation: A Focused Review

Cited by 101 publications

References 36 publications

A cellular and proteomic approach to assess proteins extracted from cryopreserved human amnion in the cultivation of corneal stromal keratocytes for stromal cell therapy

A cellular and proteomic approach to assess proteins extracted from cryopreserved human amnion in the cultivation of corneal stromal keratocytes for stromal cell therapy

Long-term clinical outcomes of keratoplasty using gamma-irradiated corneal lenticules

<p>Boston Type 1 Keratoprosthesis: Updated Perspectives</p>

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