Penetrating Keratoplasty: Indications and Graft Survival by Geographic Region

Qureshi, Sana; Dohlman, Thomas H.

doi:10.1080/08820538.2022.2152710

Cited by 9 publications

(7 citation statements)

References 175 publications

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“…[ 23 ] The review about PK showed average graft survival rates of 88.6%, 81.2%, 78.9%, 72.8%, and 61.2%, at 1, 2, 3, 5, and 10 years, respectively. [ 24 ]…”

Section: Resultsmentioning

confidence: 99%

Main issues in penetrating keratoplasty

Alió,

Niazi,

Doroodgar

et al. 2024

Taiwan Journal of Ophthalmology

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This review explores contemporary challenges in penetrating keratoplasty (PK), focusing on technical intricacies, technological advancements, and strategies for preventing graft rejection. A systematic literature search from January 2018 to July 2023 was conducted across PubMed, Cochrane, Web of Science, Scopus, and EMBASE. The inclusion criteria comprised studies on PK and its comparison with other corneal pathologies, with emphasis on keratoconus (KC). Two independent reviewers screened studies, extracting relevant data. The review covers PK evolution, highlighting infra-red femtosecond lasers’ impact on graft shapes, minimizing astigmatism, and enhancing wound healing. Graft rejection, a primary complication, is examined, detailing risk factors and preventive measures. Preoperative considerations, diagnostic techniques for rejection, and PK in KC are discussed. Postoperative care’s significance, including intraocular pressure monitoring and steroid administration, is emphasized. The paper concludes with a comprehensive approach to prevent graft rejection, involving topical and systemic medications. An outlook on evolving monoclonal antibody research is presented. As the field progresses, personalized approaches and ongoing therapeutic exploration are expected to refine strategies, enhancing PK outcomes.

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“…[ 23 ] The review about PK showed average graft survival rates of 88.6%, 81.2%, 78.9%, 72.8%, and 61.2%, at 1, 2, 3, 5, and 10 years, respectively. [ 24 ]…”

Section: Resultsmentioning

confidence: 99%

Main issues in penetrating keratoplasty

Alió,

Niazi,

Doroodgar

et al. 2024

Taiwan Journal of Ophthalmology

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“…Corneal transplantation may be required in approximately 12%-20% of all patients with KC, and KC is the most common reason for corneal transplantation in numerous countries. [7][8][9] The frequency of performing DALK has increased over the years as a result of the improvement of surgical techniques and also experience. 10 Previous hydrops is a surgical challenge for DALK because of the risk of DM perforation.…”

Section: Discussionmentioning

confidence: 99%

“…However, in recent years, predescemetic DALK surgical techniques have been defined; furthermore, there were studies reported using Anwar's technique, which was also considered to be contraindicated. [7][8][9][10][11][12][13][14][15] In this study, we aimed to compare PK and DALK surgeries in keratoconic eyes with a corneal hydrops scar in terms of visual and refractive results and complications. To the best of our knowledge, apart from this study, there was only 1 study comparing PK and DALK surgeries in eyes with hydrops.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty in Keratoconic Eyes With Previous Hydrops-Related Corneal Scar

Atik

Emul

Kirgiz

et al. 2023

Cornea

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This study aimed to compare the outcomes of deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) procedures in keratoconic eyes with a previous hydrops-related corneal scar. Methods:In this retrospective study, the medical records of patients who had hydrops-related corneal scarring and underwent keratoplasty surgery were reviewed. Patients treated with DALK were classified as group 1, and patients treated with PK as group 2. Preoperative and postoperative best-corrected visual acuity, central corneal thickness, keratometry (K), and refractive error values of each group were recorded and compared.Results: Seventy-eight eyes (41 in group 1 and 37 in group 2) were included in this study. The mean follow-up period of the patients was 37.7 6 30.0 months in group 1 and 51.2 6 29.4 months in group 2 (P = 0.06). The preoperative and postoperative best-corrected visual acuity and central corneal thickness values were statistically similar in both groups (each P value .0.05). Keratometry values (K1 and mean keratometry) were significantly steeper in group 1 (P 1 = 0.02 and P 2 = 0.03, respectively). Descemet membrane perforation was experienced in 7 (4 macroperforation and 3 microperforation; 15.6%) of 45 eyes that planned to perform DALK. These 4 eyes with macroperforation underwent PK and were excluded from the study. When all postoperative complications were assessed, although the total complication rate was 21% after DALK, it was 43% after PK (P = 0.04).Conclusions: DALK with a big-bubble technique is a feasible surgery in eyes with corneal scarring due to previous hydrops and is comparable with PK in terms of visual and refractive outcomes. This study suggests that DALK, which is safer than PK with less postoperative complication rates, should be the primary surgical option to avoid serious complications in keratoconic eyes with hydrops-related corneal scarring.

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“…Within the developed countries, keratoplasties are most commonly carried out for keratoconus, pseudophakic or aphakic bullous keratopathy and re-grafts. 7,[13][14][15] This is in contrast to developing countries where corneal scars, ocular trauma, and infectious keratitis are the most common indications for a corneal graft. 7,13,16,17 The importance of this difference in indications is reflected in the stark difference in the survival rates of grafts with the latter group having a poorer prognosis.…”

Section: Revised Amendments From Versionmentioning

confidence: 99%

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

Kate,

Basu

2024

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 to 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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Penetrating Keratoplasty: Indications and Graft Survival by Geographic Region

Cited by 9 publications

References 175 publications

Main issues in penetrating keratoplasty

Main issues in penetrating keratoplasty

Comparison of Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty in Keratoconic Eyes With Previous Hydrops-Related Corneal Scar

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

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