Outcomes of Penetrating Keratoplasty After Open Globe Injury

Li, Katie X.; Durrani, Asad F.; Zhou, Yunshu; Zhao, Peter Y.; Tannen, Bradford; Musch, David C.; Zacks, David N.

doi:10.1097/ico.0000000000002918

Cited by 4 publications

(4 citation statements)

References 35 publications

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“…Many OGIs require additional secondary surgeries after the initial repair with the goal of maximizing or restoring vision. The possible interventions may include pars plana vitrectomy (PPV) ( 4 , 5 ), penetrating keratoplasty (PKP) ( 6 ), iris reconstruction, glaucoma surgery ( 7 ), cataract surgery ( 8 ), and lens placement ( 9 , 10 ), to name a few. Although much has been studied on the outcomes of anterior and posterior segment surgeries, the entire surgical rehabilitative process after OGI is less well documented.…”

Section: Introductionmentioning

confidence: 99%

Visual outcomes of the surgical rehabilitative process following open globe injury repair

Sather,

Molleti,

Moon

et al. 2024

Front. Ophthalmol.

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BackgroundThe path of rehabilitation of an eye after open globe injury (OGI) may require multiple additional secondary surgeries after the initial repair. Although much has been studied regarding the outcomes of secondary surgeries after open globe repair, it can be challenging to understand the possible implications of the surgical rehabilitative process. This retrospective study considers the benefits of the required additional secondary surgeries for a consecutive series of OGI patients.MethodsOGI patients who had at least one additional surgery after the initial open globe repair (OGR) were studied retrospectively. Additional inclusion criteria included: follow up of at least 12 months since the initial injury and at least 3 months since their most recent surgery, and no additional planned interventions. Preoperative visual acuity was compared to final visual acuity. Additionally, the odds of achieving ambulatory vision (≥20/800) and reading vision (≥20/40) were calculated after each indicated consecutive surgery.ResultsA cohort of 74 eyes from 73 patients met our inclusion criteria. These patients underwent a mean of two additional surgeries. The mean logMAR VA improved from 2.3 (HM) at presentation to 1.4 (20/150), or a 9-line Snellen equivalent improvement. Upon reaching their final visit status, 50% of patients had achieved ambulatory vision and 30% of patients had achieved reading vision. The odds of achieving ambulatory vision after completion of all the rehabilitative surgical process compared to the vision prior to the secondary rehabilitative surgery were higher (OR: 19.1, 95% CI: 7.9 – 30.4, p = 0.0008) as were the odds of achieving reading vision (OR: 4.6, 95% CI: 0.2 – 9.0, p = 0.04). With subsequent second, third, and fourth additional surgeries, the odds of achieving either ambulatory or reading vision at the final visit compared to their preoperative visual acuities were not significant (p > 0.05) but the visual acuity continued to trend toward visual improvement.ConclusionApproximately 50% of individuals who required additional surgery at UMN achieved ambulatory vision and 30% achieved reading vision. The odds of visual improvement through the surgical rehabilitative process were very high, with the greatest gains generally achieved after the first surgery.

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Section: Introductionmentioning

confidence: 99%

Visual outcomes of the surgical rehabilitative process following open globe injury repair

Sather,

Molleti,

Moon

et al. 2024

Front. Ophthalmol.

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“…The magnitude of this secondary glaucomatous complication has most likely been underestimated in the past due to its frequently delayed manifestation, sometimes many years (“time bomb”). Epidemiological studies on secondary glaucoma are therefore limited and numbers citing incidence and outcomes vary substantially with geography and level of economy of the area ( Dana et al, 1995 ; Doren et al, 1990 ; Dubey et al, 2019 ; Gong et al, 2021 ; Li et al, 2022 ; Suleiman et al, 2004 ; Thylefors & Négrel, 1994 ). One source estimated that about six million patients in the world have secondary glaucoma compared with 67 million with the primary glaucoma ( Quigley & Broman, 2006 ).…”

Section: Introductionmentioning

confidence: 99%

The prophylactic value of TNF‐α inhibitors against retinal cell apoptosis and optic nerve axon loss after corneal surgery or trauma

Paschalis,

Zhou,

Sharma

et al. 2023

Acta Ophthalmologica

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Background and PurposeLate secondary glaucoma is an often‐severe complication after acute events like anterior segment surgery, trauma and infection. TNF‐α is a major mediator that is rapidly upregulated, diffusing also to the retina and causes apoptosis of the ganglion cells and degeneration of their optic nerve axons (mediating steps to glaucomatous damage). Anti‐TNF‐α antibodies are in animals very effective in protecting the retinal cells and the optic nerve—and might therefore be useful prophylactically against secondary glaucoma in future such patients. Here we evaluate (1) toxicity and (2) efficacy of two TNF‐α inhibitors (adalimumab and infliximab), in rabbits by subconjunctival administration.MethodsFor drug toxicity, animals with normal, unburned corneas were injected with adalimumab (0.4, 4, or 40 mg), or infliximab (1, 10, or 100 mg). For drug efficacy, other animals were subjected to alkali burn before such injection, or steroids (for control). The rabbits were evaluated clinically with slit lamp and photography, electroretinography, optical coherence tomography, and intraocular pressure manometry. A sub‐set of eyes were stained ex vivo after 3 days for retinal cell apoptosis (TUNEL). In other experiments the optic nerves were evaluated by paraphenylenediamine staining after 50 or 90 days. Loss of retinal cells and optic nerve degeneration were quantified.ResultsSubconjunctival administration of 0.4 mg or 4.0 mg adalimumab were well tolerated, whereas 40.0 mg was toxic to the retina. 1, 10, or 100 mg infliximab were also well tolerated. Analysis of the optic nerve axons after 50 days confirmed the safety of 4.0 mg adalimumab and of 100 mg infliximab. For efficacy, 4.0 mg adalimumab subconjunctivally in 0.08 mL provided practically full protection against retinal cell apoptosis 3 days following alkali burn, and infliximab 100 mg only slightly less. At 90 days following burn injury, control optic nerves showed about 50% axon loss as compared to 8% in the adalimumab treatment group.ConclusionsSubconjunctival injection of 4.0 mg adalimumab in rabbits shows no eye toxicity and provides excellent neuroprotection, both short (3 days) and long‐term (90 days). Our total. accumulated data from several of our studies, combined with the present paper, suggest that corneal injuries, including surgery, might benefit from routine administration of anti‐TNF‐α biologics to reduce inflammation and future secondary glaucoma.

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“…The magnitude of this secondary glaucomatous complication has most likely been underestimated in the past due to its frequently delayed manifestation, sometimes many years ("time bomb"). Epidemiological studies on secondary glaucoma are therefore limited and numbers citing incidence and outcomes vary substantially with geography and level of economy of the area [31][32][33][34][35][36][37] . One source estimated that about 6 million patients in the world have secondary glaucoma compared with 67 million with the primary glaucomas 4 .…”

Section: Introductionmentioning

confidence: 99%

The prophylactic value of TNF-α inhibitors against retinal cell apoptosis and optic nerve axon loss after corneal surgery or trauma

Paschalis

Zhou

Sharma

et al. 2022

Preprint

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Background and Purpose: Late secondary glaucoma is an often severe complication after acute events like anterior segment surgery, trauma, infection, etc. TNF-α is a major mediator that is rapidly upregulated, diffusing also to the retina and causes apoptosis of the ganglion cells and degeneration of their optic nerve axons (mediating steps to glaucomatous damage). Anti-TNF-α antibodies are in animals very effective in protecting the ganglion cells and the optic nerve - and might therefore be useful prophylactically against secondary glaucoma in patients. Here we evaluate 1) toxicity and 2) efficacy of two TNF-α inhibitors (adalimumab and infliximab), in rabbits by subconjunctival administration. Methods: For drug toxicity, animals with normal, unburned corneas were injected with adalimumab (0.4, 4, or 40 mg), or infliximab (1, 10, or 100 mg). For drug efficacy, other animals were subjected to alkali burn before such injection, or steroids. The rabbits were evaluated clinically with slit lamp and photography, electroretinography, optical coherence tomography, and intraocular pressure manometry. Some eyes were stained ex vivo after 3 days for retinal ganglion cell apoptosis (TUNEL). In other experiments the optic nerves were evaluated with paraphenylenediamine staining after 50 or 90 days. Loss of retinal ganglion cells and optic nerve degeneration were quantified. Results: Subconjunctival administration of 0.4 mg or 4.0 mg adalimumab were well tolerated, whereas 40.0 mg was toxic to the retina. 1, 10, or 100 mg infliximab were also well tolerated. Analysis of the optic nerve axons after 50 days confirmed the safety of 4.0 mg adalimumab or of 100 mg infliximab. For efficacy, 4.0 mg adalimumab subconjunctivally in 0.08 mL provided practically full protection against ganglion cell apoptosis 3 days following alkali burn, and infliximab 100 mg only slightly less. At 90 days following a burn, the control optic nerve showed about 50% axon loss but only about 8% if protected with adalimumab. Conclusions: Subconjunctival injection of 4.0 mg adalimumab in rabbits shows no eye toxicity and provides excellent neuroprotection, short (3 days) and long-term (90 days). Our total accumulated data from several studies,z combined with the present paper, suggest that corneal injuries, including surgery, might benefit from routine administration of anti-TNF-α biologics to reduce inflammation and future secondary glaucoma.

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Outcomes of Penetrating Keratoplasty After Open Globe Injury

Cited by 4 publications

References 35 publications

Visual outcomes of the surgical rehabilitative process following open globe injury repair

Visual outcomes of the surgical rehabilitative process following open globe injury repair

The prophylactic value of TNF‐α inhibitors against retinal cell apoptosis and optic nerve axon loss after corneal surgery or trauma

The prophylactic value of TNF-α inhibitors against retinal cell apoptosis and optic nerve axon loss after corneal surgery or trauma

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