The Penetrating Keratoplasty (PKP): A Century of Success

Seitz, Berthold; Szentmáry, Nóra; El-Husseiny, M; Viestenz, Arne; Langenbucher, Achim; Naumann, G. O. H.

doi:10.1007/978-3-319-24052-7_6

Cited by 23 publications

(31 citation statements)

References 79 publications

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“…0.05; *P # 0.05; **P # 0.01; ***P # 0.001; and ****P # 0.0001. membrane can be selectively removed, while maintaining the structural integrity of the host stroma. 2,[5][6][7]9 However, this study demonstrates for the first time that density and function of the subbasal corneal nerve plexus are strongly diminished in the early postoperative phase after DMEK. Moreover, we could show that these alterations are only transient, because all analyzed parameters (total nerve length, total number of nerves, number of main nerve trunks, number of nerve branching, nerve tortuosity, and nerve function measured by sensitivity) fully recovered 4 to 10 months postoperatively up to preoperative measurements.…”

Section: Discussionmentioning

confidence: 98%

“…[1][2][3][4] With descemetorhexis in Descemet stripping automated endothelial keratoplasty 5,6 and Descemet membrane endothelial keratoplasty (DMEK), 4,[7][8][9] we are now able to selectively remove the diseased endothelium and Descemet membrane [eg, in Fuchs endothelial corneal dystrophy (FECD), bullous keratopathy, and pseudoexfoliation syndrome keratopathy] while maintaining structural integrity of the host stroma. [2][3][4][5][6][7][8][9] However, it is still unclear whether corneal innervation is preserved during DMEK without changes in corneal nerves and occurrence of postoperative dry eye syndrome or neurotrophic keratopathy, a challenging condition after PK. 10 Corneal nerves that form the subbasal nerve plexus between basal the epithelium and Bowman layer, protect the ocular surface through sensory regulation of the blink reflex and release trophic factors for the regulation of epithelial integrity, proliferation, and wound healing.…”

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confidence: 99%

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Corneal Nerve Alterations After Descemet Membrane Endothelial Keratoplasty

Bucher

Hos

Matthaei

et al. 2014

Cornea

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Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

Corneal Nerve Alterations After Descemet Membrane Endothelial Keratoplasty

Bucher

Hos

Matthaei

et al. 2014

Cornea

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“…Kornea opasitesi, aşırı apikal incelme söz konusu olan ve ileri evre keratokonuslu hastalar da ise, Penetran Keratoplasti (PKP) veya Derin Ön Lamellar Korneal Transplantı (DALK) gibi doku reddi, akut veya kronik ciddi komplikasyon riskleri içeren çok daha invazif cerrahi yöntemler gerekebilmektedir. 6,7 Günümüzde teknolojik gelişmeler ile birlikte artık konduktif keratoplasti, korneal kollajen çapraz-bağlama (CXL), intra-korneal halka (ICR) gibi korneal reshaping prosedürlerine ek olarak görmeyi daha da artırıcı yeni nesil katlanır göz içi lens implantasyonları daha az invazif ve kalıcı cerrahi yöntemler olarak uygulanmaktadır. 8,9 Topografi-eşliğindeki konduktif keratoplasti, kornea yüzeyindeki daha küçük düzensizlikleri düzeltmek ve göz yüzeyini yeniden şekillendirmek için tercih edilebilir bir yöntemdir.…”

Section: Introductionunclassified

New generation intraocular lens implantations in advanced-stage keratoconus cases

Karaarslan¹

2019

Mersin Üniversitesi Sağlık Bilimleri Dergisi

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ÖzAmaç: Bu çalışmada, ileri evre keratokonuslu hastalarda, kollajen çapraz bağlama (CXL) uygulanan veya uygulanmayan intra-korneal halka (ICR) cerrahili hastaların ve bunu takip eden kalıcı lens yerleştirme işlemlerinin sonuçlarının karşılaştırılması amaçlandı. Yöntem: Kollajen çapraz bağlama uygulanan veya uygulanmayan Keraring® ICR takılmış keratokonuslu, ve daha sonradan daha iyi görme netliği için gereksinim gösteren uygun vakalara yeni nesil IOL implantasyonu da yapılan 1068 hastayı kapsayan 7 yıllık ardışık bir vaka serisinin retrospektif klinik gözlem çalışması tamamlandı. Görme keskinliği, göz içi basıncı ve komplikasyonları değerlendirmek için takip muayeneleri, ameliyat sonrası, 3 gün, 3 hafta, 3 ay, 6 ay ve 1 yıl sonunda gerçekleştirildi. Bulgular: Intrakorneal halka 607 göze yalnız, 111 göze yeni nesil ICL ve 198 göze yeni nesil multifokal katlanır PCIOL ile implante edildi. Yardımcı CXL uygulaması, 957 ICR-gözde yalnız, 119 gözde ICR + yeni nesil ICL ile ve 144 gözde ICR + yeni nesil multifocal katlanır PCIOL ile uygulandı. Tüm tedavi planları, hastaların refraksiyon değerlerinde ve kornea eğriliğinde azalmaya neden oldu ve görme keskinliğini büyük ölçüde iyileştirdi. Tüm gözlerde kornea topografisindeki dikliklerde belirgin bir düzleşme izlendi. ICR ekstrüzyonuna bağlı kornea tahrişi 18 gözde (%0.8) ICR eksplantasyonuna yol açtı. 3 hastada, ICL implantasyonu uygulaması nedeniyle kısa süreli göz içi basıncı yükselmesi görüldü ve toplam 200 ml %2'lik mannitol ile çözüldü (100 ml ICL implantasyonu sırasında ve post-op 100 ml ilave olarak). Sonuç: İleri evre keratokonuslu hastalarda, CXL ve ICR kombinasyonuna ek olarak yeni nesil fakik ya da yeni nesil katlanır pseudofakik göz içi lenslerin cerrahi implantasyonu, çok daha iyi bir görme keskinliği ve rehabilitasyonu sağlayabilmektedir. Bu sebeple, bu cerrahi uygulamalar, uygun ileri evre keratokonuslu hastalarda daha invazif, pahalı ve doku reddi riski gibi tehlikelere sahip olan keratoplasti girişimlerine göre önceden davranıldığında çok daha iyi seçenekler sunmaktadır. AbstractAim: The aim of this study is to examine the applicability of intracorneal ring (ICR) surgery, with or without collagen cross-linking (CXL) and subsequent indwelling new generation foldable ıntraocular lens placement in patients with severe keratoconus. Methods: A retrospective clinical observation study of a 7-year consecutive case series of 1,068 patients with keratoconus implanted with Keraring® ICRs, with or without CXL and new generation foldable intraocular lens implantation was completed. Follow-up examinations to assess visual acuity, intraocular pressure, and signs of complications were performed 3 days and 3 weeks postoperatively, monthly thereafter for 3 months, at the end of month 6 and 1 year. Results: ICRs were implanted alone in 607 eyes, with ICLs in 111 eyes, and with PCIOLs in 198 eyes. Adjunct CXL was performed in 957 ICR-alone eyes, 119 ICR+ICL eyes, and ICR+PCIOL 144 eyes. All treatment plans reduced refraction prescription strength, reduced corneal curvature...

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“…Today, a clear graft after normal risk keratoplasty in keratoconus with high and/or irregular astigmatism can no longer be considered “successful” [ 12 - 14 ]. There are various pre-, intra- and post-operative causes of high and/or irregular astigmatism in keratoplasty.…”

Section: Introductionmentioning

confidence: 99%

Penetrating Keratoplasty for Keratoconus – Excimer Versus Femtosecond Laser Trephination

Seitz¹,

Langenbucher²,

Häger³

et al. 2017

TOOPHTJ

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Background:In case of keratoconus, rigid gas-permeable contact lenses as the correction method of first choice allow for a good visual acuity for quite some time. In a severe stage of the disease with major cone-shaped protrusion of the cornea, even specially designed keratoconus contact lenses are no more tolerated. In case of existing contraindications for intrastromal ring segments, corneal transplantation typically has a very good prognosis.Methods:In case of advanced keratoconus – especially after corneal hydrops due to rupture of Descemet’s membrane – penetrating keratoplasty (PKP) still is the surgical method of first choice. Noncontact excimer laser trephination seems to be especially beneficial for eyes with iatrogenic keratectasia after LASIK and those with repeat grafts in case of “keratoconus recurrences” due to small grafts with thin host cornea. For donor trephination from the epithelial side, an artificial chamber is used. Wound closure is achieved with a double running cross-stitch suture according to Hoffmann. Graft size is adapted individually depending on corneal size („as large as possible – as small as necessary“). Limbal centration will be preferred intraoperatively due to optical displacement of the pupil. During the last 10 years femtosecond laser trephination has been introduced from the USA as a potentially advantageous approach.Results:Prospective clinical studies have shown that the technique of non-contact excimer laser PKP improves donor and recipient centration, reduces “vertical tilt” and “horizontal torsion” of the graft in the recipient bed, thus resulting in significantly less “all-sutures-out” keratometric astigmatism (2.8 vs. 5.7 D), higher regularity of the topography (SRI 0.80 vs. 0.98) and better visual acuity (0.80 vs. 0.63) in contrast to the motor trephine. The stage of the disease does not influence functional outcome after excimer laser PKP. Refractive outcomes of femtosecond laser keratoplasty, however, resemble that of the motor trephine.Conclusions:In contrast to the undisputed clinical advantages of excimer laser keratoplasty with orientation teeth/notches in keratoconus, the major disadvantage of femtosecond laser application is still the necessity of suction and applanation of the cone during trephination with intraoperative pitfalls and high postoperative astigmatism.

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The Penetrating Keratoplasty (PKP): A Century of Success

Cited by 23 publications

References 79 publications

Corneal Nerve Alterations After Descemet Membrane Endothelial Keratoplasty

Corneal Nerve Alterations After Descemet Membrane Endothelial Keratoplasty

New generation intraocular lens implantations in advanced-stage keratoconus cases

Penetrating Keratoplasty for Keratoconus – Excimer Versus Femtosecond Laser Trephination

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