Indications, surgical procedures and outcomes of keratoplasty at a Tertiary University-based hospital: a review of 10 years’ experience

Al-Sharif, Eman; Alkharashi, Majed

doi:10.1007/s10792-021-01731-2

Cited by 5 publications

(7 citation statements)

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“…Lameller keratoplasti tekniklerindeki gelişmelere rağmen, güncel çalışmalarda PK'nın halen uygulanan keratoplastilerin büyük çoğunluğunu oluşturduğu (%61-%95,8 aralığı) ve korneal hastalıkların tedavisinde önemli bir seçenek olarak yerini koruduğu görülmektedir 1,3,12 . Penetran keratoplasti endikasyonlarının dağılımı ve bu dağılımın zaman içindeki değişimi pek çok çalışmada bildirilmiştir [1][2][3][4]6,[12][13][14][15] . Bu çalışmalarda bildirilen sonuçlar, çalışmanın yapıldığı ülke ve bölgenin sosyoekonomik ve coğrafik özelliklerinin yanı sıra çalışmayı yapan merkezin deneyimi ve hasta profili ile ilişki göstermektedir.…”

Section: Discussionunclassified

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Indications for penetrating keratoplasty: A single tertiary health clinic experience

Harbiyeli

Erdem

Uysal

et al. 2021

Cukurova Medical Journal

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The aim of this study was to investigate the indication distribution for penetrating keratoplasty (PK) surgeries performed in our clinic and the changes observed in this distribution during the study period. Materials and Methods: Medical records of patients who underwent PK were retrospectively reviewed. Indications were examined under six main categories; corneal scarring, corneal dystrophy, keratoconus, bullous keratopathy, regraft and acute infectious keratitis. In order to examine the changes in indications over time, the study period was divided into two equal time periods and the data in these periods were compared. Results: 303 eyes of 263 patients (117 women [44.5%], 146 men [55.5%]) were included in the study. The most common indication for penetrating keratoplasty was corneal scars (76 eyes, 25.1%). While infectious keratitis sequelaes (38/76, 50%) took the first place in the etiology of corneal scarring, sequelaes due to herpetic keratitis (21/38, 55.2%) were the largest subgroup whereas the distribution according to the microbial agents was examined. In the second half of the study period, the rate of surgeries performed due to corneal dystrophy decreased, whereas the rate of patients who underwent regraft increased. Conclusion:The most common indication for PK was corneal scarring in this study. Improving health services in terms of infectious keratitis and corneal trauma cases; dissemination of social projects and genetic counseling services for the prevention of consanguineous marriages in terms of corneal dystrophies will reduce vision loss due to corneal pathologies in this region. Amaç: Bu çalışmada bir üçüncü basamak sağlık merkezinde uygulanan penetran keratoplasti (PK) ameliyatlarının endikasyon dağılımının ve çalışma periyodu içerisinde bu dağılımda görülen değişimlerin incelenmesi amaçlanmıştır. Gereç ve Yöntem: PK ameliyatı geçiren hastaların tıbbi kayıtları retrospektif olarak incelendi. Endikasyonlar; korneal skar, korneal distrofi, keratokonus, büllöz keratopati, regreft ve akut enfeksiyöz keratit olmak üzere altı ana kategori altında incelendi. Endikasyonların zaman içerisindeki değişimini inceleyebilmek amacıyla çalışma periyodu iki eşit zaman dilimine ayrıldı ve bu iki periyottaki veriler karşılaştırıldı. Bulgular: İki yüz altmış üç hastanın (117 kadın [%44,5], 146 erkek [%55,5]) 303 gözü çalışmaya dahil edildi. Penetran keratoplastinin en sık endikasyonu korneal skarlar (76 göz, %25,1) idi. Enfeksiyöz keratit sekelleri (38/76, %50) korneal skar etyolojisi içerisinde ilk sırayı alırken, etkenlere göre dağılım incelendiğinde herpetik keratite bağlı sekeller (21/38, %55,2) en büyük alt grubu oluşturmaktaydı. Çalışma periyodunun 2. yarısında korneal distrofi nedeniyle uygulanan cerrahilerin oranının azaldığı, regreft uygulanan olguların oranının ise artış gösterdiği saptandı. Sonuç: Çalışmamızda PK'nın en sık nedeni korneal skar olarak bulunmuştur.. Enfeksiyöz keratit ve korneal travma olguları açısından sağlık hizmetlerinin iyileştirilmesi; korneal distrofiler açısından ise akraba evl...

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Section: Discussionunclassified

“…Çalışmamızda da BK'nın PK endikasyonları içerisindeki oranı çalışma periyodunun ikinci yarısında daha düşük idi (p=0,058, Şekil 2) ve tüm çalışma periyodu içerisindeki oran %16,1 olarak bulundu. Bu oran, ülkemizden ve dünyadan bildirilen güncel sonuçlar ile (%13-18,5 aralığı) paralellik göstermektedir 5,12,39 .…”

Section: Discussionunclassified

Indications for penetrating keratoplasty: A single tertiary health clinic experience

Harbiyeli

Erdem

Uysal

et al. 2021

Cukurova Medical Journal

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“…In penetrating keratoplasty (PKP), the full-thickness cornea is transplanted to the recipient and rejection may occur in any of the corneal layers. Rejection rates for low to intermediate-risk PKP range from 4 to 35.6% with up to 25 years of follow-up [35,44,45,46 ▪ ,47–53,54 ▪ ,55–63,64 ▪ ,65,66,67 ▪ ,68–74,75 ▪ ]. The range of published rejection rates at specific times-since-transplant are reported in Table 2.…”

Section: Understanding Rejection Riskmentioning

confidence: 99%

“…Endothelial rejections do not occur as the recipient retains their own Descemet's membrane and endothelium, but epithelial, subepithelial, and stromal reactions are still possible [77,78,143]. DALK rejection rates range from 0 to 21.2% with up to 10 years of follow-up (Table 2) [45,46 ▪ ,64 ▪ ,65,66,68,77–81,83,84,134 ▪▪ ,140 ▪▪ ,144]. Rejection risk in DALK is highest during the first year and subsides as the host epithelial cells and keratocytes repopulate the donor tissue but several studies report an average time-to-rejection between 1 and 2 years [35,45,65,77–79,84,144].…”

Section: Understanding Rejection Riskmentioning

confidence: 99%

“…Descemet's stripping endothelial keratoplasty (DSEK) involves transplantation of the endothelial, Descemet's membrane, and inner stromal layers [35]. Rejection rates range from 0 to 20.7% with up to 10 years of follow-up (Table 2) [38,47,49,55,59,64 ▪ ,67 ▪ ,85 ▪ ,86 ▪ ,87 ▪ ,88–93,95–99,100 ▪ –106 ▪ ,107]. Whether or not rejection rates plateau after 3 years largely depends on continued topical corticosteroid usage [38,47,59,90,92,93,95,96,103 ▪ ,133,146].…”

Section: Understanding Rejection Riskmentioning

confidence: 99%

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Impact of vaccination on keratoplasty

Dugan

2022

Current Opinion in Ophthalmology

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Purpose of reviewCorneal graft rejection has been reported after coronavirus disease 2019 (COVID-19) vaccination. The purpose of this review is to evaluate the literature regarding corneal graft rejection after vaccination, including rejection rates and risk factors. We aim to create a framework to identify patients who are at higher risk for graft rejection and may warrant consideration of prophylactic interventions.Recent findingsGraft rejection has been reported following administration of mRNA, viral vector, and inactivated whole-virion COVID-19 vaccines. Most cases had additional risk factors associated with rejection. Vaccination increases circulation of proinflammatory cytokines, CD4+ and CD8+ T-cell responses, and antispike neutralizing antibody, all of which may contribute to graft rejection. Two prospective studies have found no relationship between recent vaccination and rejection but 20% of cornea specialists report to have seen a vaccine-associated rejection and 22% recommend delaying vaccination in certain circumstances. Many specialists recommend prophylactic topical corticosteroids before and after vaccination to mitigate rejection risk but there is no evidence to support this practice on a wider scale.SummaryOur framework identified 96.8% of penetrating keratoplasty patients with vaccine-associated rejection as higher risk. Further research is needed in order to develop evidence-based guidelines.

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Corneal blindness in the developing world: The role of prevention strategies

Kate,

Basu

2023

F1000Res

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Corneal blindness is an important contributor to the burden of global blindness and has a greater prevalence in low-income countries of the developing world where resources and infrastructure are limited. The causes of corneal blindness too are different from high-income countries and include infectious keratitis, ocular trauma, and xerophthalmia. Persons with these indications tend to have unfavourable outcomes after corneal transplantation, limiting their chances of benefitting from this sight-saving procedure. However, most causes of corneal blindness in the developing world are preventable. This highlights the importance of understanding the unique challenges in these regions and the need for targeted interventions. This article discusses various prevention strategies, including primordial, primary, and secondary prevention, aimed at reducing the burden of corneal blindness in low-income countries. These include capacity building, training, and awareness campaigns to reduce the risk factors of ocular trauma, infectious keratitis, and improve access to first aid. It is also important to promote safe eye practices and tackle nutritional deficiencies through public health interventions and policy changes. Providing the required training to general ophthalmologists in the management of basic corneal surgeries and diseases and enhancing the accessibility of eye care services in rural areas will ensure early treatment and prevent sequelae. Current treatment modalities belong to the tertiary level of prevention and are largely limited to corneal transplantation. In developing nations, there is a scarcity of donor corneal tissue necessitating an urgent expansion of eye banking services. Alternative approaches to corneal transplantation such as 3D printed corneas, cultured stem cells, and biomaterials should also be explored to meet this demand. Thus, there is a need for collaborative efforts between healthcare professionals, policymakers, and communities to implement effective prevention strategies and reduce the prevalence of corneal blindness in the developing world.

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Indications, surgical procedures and outcomes of keratoplasty at a Tertiary University-based hospital: a review of 10 years’ experience

Cited by 5 publications

References 57 publications

Indications for penetrating keratoplasty: A single tertiary health clinic experience

Indications for penetrating keratoplasty: A single tertiary health clinic experience

Impact of vaccination on keratoplasty

Corneal blindness in the developing world: The role of prevention strategies

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