Outcome of Therapeutic Penetrating Keratoplasty Using Glycerol-Preserved Donor Corneas in Infectious Keratitis

Thanathanee, Onsiri; Sripawadkul, Wathanee; Anutarapongpan, Orapin; Luanratanakorn, Patanaree; Suwan-apichon, Olan

doi:10.1097/ico.0000000000000841

Cited by 12 publications

(12 citation statements)

References 16 publications

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“…Compared with fresh donor corneas, glycerol-preserved corneas have several potential advantages, such as increased availability, weak graft rejection and low risk of microbial contamination [21]. Glycerol-preserved corneas, with a graft size ranging from 2 to 8 mm [22] and 7 to 10 mm [23], had been applied for TPK in infectious keratitis, which showed postoperative complications such as reinfection, secondary PK, opacification or glaucoma. Shi et al [13] reported cases treated eccentric corneal perforations by PK using glycerol-preserved small-diameter corneal grafts (2.5–4.5 mm), which showed all grafts remained clear at the end of a follow-up period from 7 to 36 months.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, some researchers have found that the residual corneal endothelial cells beyond the perforation may migrate and cover the posterior graft surface after PK with glycerol-preserved corneas [13]. Therefore, an increasing number of investigators in different countries are trying to use glycerol-preserved donor corneas for therapeutic penetrating keratoplasty (TPK) in patients with corneal perforations [13, 22, 23].…”

Section: Introductionmentioning

confidence: 99%

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Individualized penetrating keratoplasty using edge-trimmed glycerol-preserved donor corneas for perforated corneal ulcers

Niu¹,

Zhou²,

Huang³

et al. 2019

BMC Ophthalmol

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Purpose To report a surgical technique and the surgical outcomes of individualized penetrating keratoplasty (PK) using edge-trimmed glycerol-preserved donor corneas for perforated corneal ulcers. Methods Fourteen perforated eyes from 14 patients who underwent individualized PK using edge-trimmed glycerol-preserved donor corneas, were included in the retrospective study. The perforations were mainly 1–2 mm in size except for one that was 2.5 × 4 mm. Three patients were treated with PK; one patient was treated with PK and a conjunctival flap; ten patients who had large ulcer areas were treated with PK combined with lamellar keratoplasty (LK). Donor corneas were preserved in sterile pure glycerol at − 80 °C. Corneal grafts were specially edge-trimmed to match the perforation, and then sutured onto the recipient bed avoiding the visual axis. Results All 14 patients recovered anatomical integrity without reinfections of the treated eyes. All patients had improved graft transparency and uncorrected visual acuity after surgery. Among them, four patients suffered from short-term postoperative complications and recovered quickly; four patients suffered from long-term postoperative complications, of them, one was performed further treatment. Conclusion After individualized PK using glycerol-preserved donor corneas, all perforated corneal ulcers were stably controlled by the end of the follow-up period. This modified surgical technique can be a potential treatment choice for patients with perforated corneal ulcers.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Individualized penetrating keratoplasty using edge-trimmed glycerol-preserved donor corneas for perforated corneal ulcers

Niu¹,

Zhou²,

Huang³

et al. 2019

BMC Ophthalmol

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“…Hyphema was associated with surgical delay and the use of large graft, and was often due to the presence of refractory infection and multiple neovascularization 24. A large graft was a significant associated factor for graft rejection 21. In the present study, the diameter of graft was often equal to or larger than 8.75 mm (389/561, 69.3%), which was due to the extensive range of severe infiltration.…”

Section: Discussionmentioning

confidence: 49%

“…In our study cryopreserved corneas were used as emergency keratoplasty for severe keratitis with perforation or that affected the limbus and sclera when no fresh donor cornea was available. Other reports also demonstrated that cryopreserved donor corneas could be effectively applied for TKP even in patients with a large corneal perforation 20,21. The use of cryopreserved donor corneas was also necessary in view of the extreme shortage of donor corneas in China 19…”

Section: Discussionmentioning

confidence: 99%

<p>Outcomes of therapeutic keratoplasty for severe infectious keratitis in Chongqing, a 16-year experience</p>

Zhāng

Zhao

et al. 2019

IDR

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Purpose This study aimed to evaluate the outcomes of therapeutic keratoplasty for severe infectious keratitis in Chongqing (Southwest China). Patients and methods The records of 561 eyes that underwent therapeutic keratoplasty for refractory microbial keratitis from 2001 to 2016 were analyzed in this retrospective study. Data included demographic information, microbiological investigations, associated factors, graft size, preoperative status, postoperative complications, and final anatomical outcomes. Results Trauma was the most common cause (267, 47.6%) for corneal ulcers leading to therapeutic keratoplasty. The etiological diagnosis included bacterial keratitis (80 eyes, 14.3%), fungal keratitis (317 eyes, 56.5%), acanthamoeba keratitis (3 eyes, 0.5%), and mixed bacteria/fungal infection (15 eyes, 2.7%). Anatomical success was achieved for 492 eyes (87.7%), with bacterial keratitis having a better outcome than fungal and mixed infections. Diabetes and preoperative time ≥30 days were significantly associated with anatomical failure in the multivariate logistic regression ( P =0.028 and P =0.022, respectively). Patients with hypopyon, corneal perforation, surgical delay, and/or large graft size had a higher incidence of postoperative complications (reinfection, cataract, glaucoma, hyphema, or graft rejection) ( P <0.05). Conclusion Therapeutic keratoplasty was an effective procedure in managing refractory infectious keratitis. Prompt and appropriate surgery would result in fewer complications and better outcomes.

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“…28,29 A recent case series of therapeutic PK using glycerolpreserved corneas performed for infectious keratitis, in which fungal etiology accounted for the majority of cases, showed that almost 41% of eyes required evisceration or enucleation. 30 The indication for such an early surgical approach comes from the authors' desire of not ' losing' any eye because of complications such as endophthalmitis, phthisis, or evisceration, and neither to perform a PK that has definitely lower graft survival and higher risk of more severe complications than DALK. 31…”

Section: Discussionmentioning

confidence: 99%

Early deep anterior lamellar keratoplasty for fungal keratitis poorly responsive to medical treatment

Sabatino

Sarnicola

et al. 2017

Eye

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PurposeTo investigate the efficacy of early therapeutic deep anterior lamellar keratoplasty (DALK) in eradicating fungal keratitis that is poorly responsive to medical treatment.Patients and methodsTwenty-three eyes (23 patients) underwent early therapeutic DALK within 15 to 50 days from the onset of symptoms. The adopted eligibility criteria for early DALK included the following: active fungal keratitis affecting the optical zone with ulcer confined in the 6.00 mm central cornea; deeper than 150 μm but not exceeding 300 μm; and poorly responsive to medical treatment.ResultsThe big bubble technique was accomplished in 74% (17) of eyes, whereas manual dissection was performed in the remaining 26% (6) of eyes. Histopathological examination did not show any sign of fungal colonization in the peripheral and deep stromal lamellae in any case. All grafts were transparent postoperatively, and no recurrence of infection occurred. Median best spectacle corrected visual acuity significantly improved from 2.0 (1.0 interquartile range) logMAR to 0.1 (0.1 interquartile range) logMAR (P<0.01). The mean follow-up was 32±10 months. Neither episode of rejection nor graft failure was noted during the follow-up period.ConclusionEarly DALK could represent a safe therapeutic approach to eradicate fungal keratitis that affects the optical zone and is poorly responsive to medical treatment.

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Outcome of Therapeutic Penetrating Keratoplasty Using Glycerol-Preserved Donor Corneas in Infectious Keratitis

Abstract: TPK using glycerol-preserved corneas has a high rate of secondary glaucoma and recurrence of infection with unsatisfactory visual results. These corneas may be used as temporary emergency transplants in infectious keratitis when fresh corneas are unavailable to meet demands.

Cited by 12 publications

References 16 publications

Individualized penetrating keratoplasty using edge-trimmed glycerol-preserved donor corneas for perforated corneal ulcers

Individualized penetrating keratoplasty using edge-trimmed glycerol-preserved donor corneas for perforated corneal ulcers

<p>Outcomes of therapeutic keratoplasty for severe infectious keratitis in Chongqing, a 16-year experience</p>

Early deep anterior lamellar keratoplasty for fungal keratitis poorly responsive to medical treatment

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