Trends in surgical procedures and indications for corneal transplantation over 27 years in a tertiary hospital in Japan

Takahashi, Aya; Yamaguchi, Takefumi; Tomida, Daisuke; Nishisako, Sota; Sasaki, Chiaki; Shimazaki, Jun

doi:10.1007/s10384-021-00849-1

Cited by 10 publications

(15 citation statements)

References 38 publications

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“…However, these results for donor risk factors after DSAEK were obtained in the United States or Europe, where Fuchs' endothelial corneal dystrophy (FECD) is the most common indication in recipient cohorts. In contrast, the indications for DSAEK in Asian countries are different: 70% of endothelial keratoplasties in these countries were performed for treating pseudophakic bullous keratopathy (PBK) or laser-iridotomy-related bullous keratopathy (LIBK), and the number of cases involving FECD accounted for approximately 10% of all transplants (14)(15)(16). Although a thorough assessment of donor-related risk factors to improve graft survival after DSAEK is essential, the data for cases involving non-FECD corneal edema disease in Asian countries have been scarce.…”

Section: Introductionmentioning

confidence: 99%

Donor-Related Risk Factors for Graft Decompensation Following Descemet's Stripping Automated Endothelial Keratoplasty

et al. 2022

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AimsTo identify donor-related risk factors associated with graft endothelial failure and postoperative endothelial cell density (ECD) reduction after Descemet's stripping automated endothelial keratoplasty (DSAEK).MethodsThis was a single-center retrospective study conducted from July 2006-December 2016. We included 584 consecutive eyes (482 patients) that underwent DSAEK for the treatment of laser iridotomy-related bullous keratopathy (192 eyes), pseudophakic bullous keratopathy (137 eyes), regraft (96 eyes), Fuchs' endothelial corneal dystrophy (FECD; 59 eyes) and others (100 eyes). Twenty-three donor- and recipient-related risk factors potentially associated with graft failure and ECD reduction were assessed using Cox hazard models and linear mixed effect models.ResultsThe median age of the patients was 73.5 years (male; 35.6%). After DSAEK, ECD decreased from 2,674 cells/mm2 (95% confidence interval [CI]; 2,646–2,701) to 1,132 (1,076–1,190) at 12 months and 904 (845–963) at 24 months (P < 0.001). Fifty-five eyes (9.4%) had graft endothelial failure without rejection. This failure was associated with donor pseudophakic lens status (hazard ratio [HR]; 2.67, CI; 1.50–4.76, P = 0.001) and preoperative endothelial folds (HR; 2.82, CI; 1.20–6.62, P = 0.02). The incidence of graft endothelial failure in non-FECD patients was significantly higher among those receiving donor grafts with a pseudophakic lens status and preoperative presence of endothelial folds (P < 0.001). Postoperative ECD loss was significantly greater in eyes with these risk factors compared to those without (P = 0.007).ConclusionsPseudophakic status and/or presence of preoperative endothelial folds are the significant donor risk factors for endothelial failure in non-FECD patients.

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Section: Introductionmentioning

confidence: 99%

Donor-Related Risk Factors for Graft Decompensation Following Descemet's Stripping Automated Endothelial Keratoplasty

et al. 2022

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“…Anterior lamellar keratoplasty replaces the anterior part of the corneal stroma, leaving a healthy Descemet membrane and endothelium layer. Indications for this procedure include corneal pathologies such as anterior dystrophies and degenerations 1 , corneal scars 2 , keratoconus 3 , and corneal ulcers at risk of perforation 4 . The most critical and challenging part of lamellar surgery is separating corneal tissue at the appropriate depth (which depends on the extent of corneal pathology) to leave a plain bed for the corneal graft.…”

Section: Introductionmentioning

confidence: 99%

Clinical Evaluation of The Efficacy of Femtosecond Laser-Assisted Anterior Lamellar Keratoplasty with Long-Term Follow-Up.

Wylęgała

Kokot

Roszkowska

et al. 2022

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Introduction: To evaluate the clinical outcome, efficacy, and safety of femtosecond laser-assisted anterior lamellar keratoplasty. Material and Methods: In this prospective study, 32 patients (21M and 10F) aged from 15 to 62 years (mean 38.5) with different pathologies of the anterior corneal layers were enrolled for anterior lamellar keratoplasty using femtosecond laser VisuMax (Carl Zeiss, Germany). All patients were examined for uncorrected (UCVA) and best-corrected (BCVA) distance and near visual acuity, astigmatism, endothelial cell density, corneal thickness, and intraocular pressure. These examinations were performed before transplantation, at hospital discharge, and after 3 and 12 months. The mean follow-up time was 65.36 ± 28.54 months. Results: Statistically significant improvement of both UCVA and BCVA for distance and near vision was registered. BCVA improved from 0.11 preoperatively to 0.168 (p = 0.03), 0.267 (p < 0.01) and 0.472 (p < 0.01) on the hospital discharge day, 3 months and 12 months respectively. There were no statistically significant differences in astigmatism, intraocular pressure, endothelial cell density, and corneal pachymetry as compared preoperative and postoperative values. Six patients (19%) had a graft failure with a rate of 33% at 26 months. Conclusions: Femtosecond laser-assisted anterior lamellar keratoplasty is a safe and effective surgical method, providing satisfactory graft survival rates.

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“…Despite PKP remains as the gold standard in various indications, in the last decades, other corneal transplantation techniques-anterior and posterior lamellar keratoplasties-have been developed, which have shown to have several advantages. In several recent studies endothelial pathologies (bullous keratopathy, Fuchs endothelial dystrophy and regraft) have become the main indications for corneal transplantation, and this shift stimulated the need to search for less invasive procedures [2,[5][6][7][8]. Due to its multiple advantages over the PKP, resulting from the possibility of selective replacement of corneal layers, lamellar keratoplasty techniques have dominated PKP in specific indications [9].…”

Section: Introductionmentioning

confidence: 99%

“…Indications and techniques for corneal transplant vary by geographic regions, which is influenced not only by the prevalence of certain corneal diseases but also by the state of health service and economy [1,12]. The number of performed lamellar keratoplasties depends on various factors regarding tissue availability, early diagnosis of corneal diseases, dominant indications for keratoplasty, and advances in other ophthalmic procedures like cataract surgery and cross-linking [7,13]. The experience of the surgeon is also important, as the fear of damaging the graft during preparation or of failure of the operation due to a more complicated technique may affect the more willing choice of penetration technique.…”

Section: Introductionmentioning

confidence: 99%

Indications and techniques of corneal transplants performed in one center in Southern Poland, in the years 2001–2020

et al. 2022

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Purpose The study aimed to evaluate changes over a period of time in techniques and indications for corneal transplantation in a single center in Poland. Methods Retrospective analysis of corneal transplants performed at the Ophthalmology Department of the District Railway Hospital in Katowice in 2001–2020. Data on indications and surgical technique were collected. Results A total of 3021 corneal transplantations were performed in the years 2000–2020. The most common technique was penetrating keratoplasty (69,54%), then lamellar grafts—both anterior and posterior (19,63%), and limbal grafts (10,82%). Only in 2007 the number of lamellar keratoplasties exceeded the number of penetrating grafts and accounted for 108 (54,55%), including 85 (42,93%) of Descemet Stripping Automated Endothelial Keratoplasty. The only noticeable trend in changing techniques was a decrease in the number of performed deep anterior lamellar keratoplasties (r 2 = -0.21) over the last seven years. Main indications included bullous keratopathy (23,22%), following keratoconus (18,59%), leukoma (14,67%), keratitis and perforation (14,3%), Fuchs dystrophy (11,4%), and regrafts (7,22%). Leukoma and bullous keratopathy as an indications for corneal transplant have been declining over the years (r2 = 0.60 and r2 = 0.30 respectively). Consecutively, indications such as fuchs dystrophy, regraft and keratitis perforation have increased (r2 = 0.05, r2 = 0.50, r2 = 0.33) Conclusions The number of keratoplasties gradually increased from 2001 to 2020. It could be possible that the development and spread of new therapeutic alternatives, like corneal cross-linking and scleral lenses, have contributed to the decrease in deep anterior lamellar keratoplasty performed. There was an increasing trend in the percentage of penetrating keratoplasties for failed grafts, Fuchs dystrophy and infectious keratitis.

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Trends in surgical procedures and indications for corneal transplantation over 27 years in a tertiary hospital in Japan

Cited by 10 publications

References 38 publications

Donor-Related Risk Factors for Graft Decompensation Following Descemet's Stripping Automated Endothelial Keratoplasty

Donor-Related Risk Factors for Graft Decompensation Following Descemet's Stripping Automated Endothelial Keratoplasty

Clinical Evaluation of The Efficacy of Femtosecond Laser-Assisted Anterior Lamellar Keratoplasty with Long-Term Follow-Up.

Indications and techniques of corneal transplants performed in one center in Southern Poland, in the years 2001–2020

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