Transepithelial Corneal Cross-Linking With Vitamin E-Enhanced Riboflavin Solution and Abbreviated, Low-Dose UV-A: 24-Month Clinical Outcomes.

 Transepithelial,Corneal Cross-Linking,Vitamin E,Riboflavin, UV-A
Cornea. 2015 Nov 23. [Epub ahead of print]

Transepithelial Corneal Cross-Linking With Vitamin E-Enhanced Riboflavin Solution and Abbreviated, Low-Dose UV-A: 24-Month Clinical Outcomes.

Abstract

PURPOSE:

To report the clinical outcomes with 24-month follow-up of transepithelial cross-linking using a combination of a D-alpha-tocopheryl polyethylene-glycol 1000 succinate (vitamin E-TPGS)-enhanced riboflavin solution and abbreviated low fluence UV-A treatment.

METHODS:

In a nonrandomized clinical trial, 25 corneas of 19 patients with topographically proven, progressive, mild to moderate keratoconus over the previous 6 months were cross-linked, and all patients were examined at 1, 3, 6, 12, and 24 months. The treatments were performed using a patented solution of riboflavin and vitamin E-TPGS, topically applied for 15 minutes, followed by two 5-minute UV-A treatments with separate doses both at fluence below 3 mW/cm that were based on preoperative central pachymetry.

RESULTS:

During the 6-month pretreatment observation, the average Kmax increased by +1.99 ± 0.29 D (diopter). Postoperatively, the average Kmax decreased, changing by -0.55 ± 0.94 D, by -0.88 ± 1.02 D and by -1.01 ± 1.22 D at 6, 12, and 24 months. Postoperatively, Kmax decreased in 19, 20, and 20 of the 25 eyes at 6 months, 12 months, and 24 months, respectively. Refractive cylinder was decreased by 3 months postoperatively and afterward, changing by -1.35 ± 0.69 D at 24 months. Best spectacle-corrected visual acuity (BSCVA) improved at 6, 12, and 24 months, including an improvement of -0.19 ± 0.13 logarithm of the minimum angle of resolution units at 24 months. There was no reduction in endothelial cell count. No corneal abrasions occurred, and no bandage contact lenses or prescription analgesics were used during postoperative recovery.

CONCLUSIONS:

Transepithelial cross-linking using the riboflavin-vitamin E solution and brief, low-dose, pachymetry-dependent UV-A treatment safely stopped keratoconus progression.This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial License 4.0 (CC BY-NC), which permits downloading, sharing, and reproducing the work in any medium, provided it is properly cited. The work cannot be used commercially.

PMID:
26606293
[PubMed – as supplied by publisher]
Transepithelial,Corneal Cross-Linking,Vitamin E,Riboflavin, UV-A

Effect of Intravitreal Injection of Methotrexate on Human Corneal Endothelial Cells.

Cornea. 2015 Nov 23. [Epub ahead of print]

Effect of Intravitreal Injection of Methotrexate on Human Corneal Endothelial Cells.

Abstract

PURPOSE:

To evaluate the toxic effect of intravitreal methotrexate on human corneal endothelium.

METHODS:

In this prospective noncomparative interventional case series, intravitreal injection of 400 μg methotrexate was performed in eyes with persistent diabetic macular edema. Corneal endothelial cell analyses and central corneal thickness measurements were performed before and 1, 3, and 6 months after injections, using noncontact specular microscopy.

RESULTS:

Twenty one eyes of 18 patients with a mean age of 60.5 ± 6.8 years were evaluated. No statistically significant difference was found in endothelial cell density, coefficient of variation, average cell area, hexagonality, and central corneal thickness measurements before and after injections (P = 0.70, 0.39, 0.43, 0.64, and 0.67, respectively).

CONCLUSIONS:

In this 6-month follow-up study, intravitreal injection of 400 μg methotrexate had no significant effect on corneal endothelial cell measurements performed by specular microscopy.

PMID:
26606294
[PubMed – as supplied by publisher]
Cornea. 2015 Nov 23. [Epub ahead of print]

Effect of Intravitreal Injection of Methotrexate on Human Corneal Endothelial Cells.

Abstract

PURPOSE:

To evaluate the toxic effect of intravitreal methotrexate on human corneal endothelium.

METHODS:

In this prospective noncomparative interventional case series, intravitreal injection of 400 μg methotrexate was performed in eyes with persistent diabetic macular edema. Corneal endothelial cell analyses and central corneal thickness measurements were performed before and 1, 3, and 6 months after injections, using noncontact specular microscopy.

RESULTS:

Twenty one eyes of 18 patients with a mean age of 60.5 ± 6.8 years were evaluated. No statistically significant difference was found in endothelial cell density, coefficient of variation, average cell area, hexagonality, and central corneal thickness measurements before and after injections (P = 0.70, 0.39, 0.43, 0.64, and 0.67, respectively).

CONCLUSIONS:

In this 6-month follow-up study, intravitreal injection of 400 μg methotrexate had no significant effect on corneal endothelial cell measurements performed by specular microscopy.

PMID:
26606294
[PubMed – as supplied by publisher]

Corneal Tattooing and Anterior Stromal Puncture for Treating Symptomatic Bullous Keratopathy.

Cornea. 2015 Nov 23. [Epub ahead of print]

Corneal Tattooing and Anterior Stromal Puncture for Treating Symptomatic Bullous Keratopathy.

Abstract

PURPOSE:

To investigate the efficacy of corneal tattooing, through anterior stromal puncture (ASP), for managing painful bullous keratopathy (BK).

METHODS:

This retrospective, case-controlled, consecutive case series study was performed at a university-based referral clinic. Patients with painful BK who underwent corneal tattooing with Chinese ink between 2007 and 2013 were included in analyses. Patients diagnosed with symptomatic BK who only underwent ASP during the same period were included as a control group.

RESULTS:

A total of 40 patients (27 men, 13 women) with a mean age of 57.5 ± 15.3 years were included in analyses. The clinical diagnosis was pseudophakic BK in 5 subjects (12.5%), failed graft in 11 subjects (27.5%), BK secondary to perforating corneal injury repair in 19 subjects (47.5%), and end-stage glaucoma in 5 subjects (12.5%). Subjects were followed for a mean period of 26.4 ± 7.5 months (range: 6-55 months). Recurrent bullae formation occurred in 3 of 31 patients (9.68%) who had undergone corneal tattooing and in all 9 patients (100%) who had undergone ASP (P < 0.001).

CONCLUSIONS:

Corneal tattooing with Chinese ink is a simple, effective outpatient procedure for treating painful BK in eyes with no visual potential.

Abstract

PURPOSE:

To investigate the efficacy of corneal tattooing, through anterior stromal puncture (ASP), for managing painful bullous keratopathy (BK).

METHODS:

This retrospective, case-controlled, consecutive case series study was performed at a university-based referral clinic. Patients with painful BK who underwent corneal tattooing with Chinese ink between 2007 and 2013 were included in analyses. Patients diagnosed with symptomatic BK who only underwent ASP during the same period were included as a control group.

RESULTS:

A total of 40 patients (27 men, 13 women) with a mean age of 57.5 ± 15.3 years were included in analyses. The clinical diagnosis was pseudophakic BK in 5 subjects (12.5%), failed graft in 11 subjects (27.5%), BK secondary to perforating corneal injury repair in 19 subjects (47.5%), and end-stage glaucoma in 5 subjects (12.5%). Subjects were followed for a mean period of 26.4 ± 7.5 months (range: 6-55 months). Recurrent bullae formation occurred in 3 of 31 patients (9.68%) who had undergone corneal tattooing and in all 9 patients (100%) who had undergone ASP (P < 0.001).

CONCLUSIONS:

Corneal tattooing with Chinese ink is a simple, effective outpatient procedure for treating painful BK in eyes with no visual potential.

Spontaneously resolving descemet’s membrane detachment caused by an ophthalmic viscosurgical device during cataract surgery.

Cataract complication, Descemet’s membrane, Descemet’s membrane detachment, Ophthalmic Viscosurgical Device (OVD), Phacoemulsification

Saudi J Ophthalmol. 2015 Oct-Dec;29(4):301-302. Epub 2015 Aug 3.

Spontaneously resolving descemet’s membrane detachment caused by an ophthalmic viscosurgical device during cataract surgery.

Abstract

We present a case of a central Descemet’s membrane detachment (DMD) induced by an Ophthalmic Viscosurgical Device during phacoemulsification surgery that resolved spontaneously, leaving a best spectacle corrected visual acuity of 20/20. The detachment was monitored with serial anterior segment optical coherence tomography images. Most cases of central DMD reported in the literature have been managed surgically to facilitate rapid visual recovery and minimize the risk of scarring. Our case adds to the literature in providing an alternative management strategy where surgical intervention may not be possible.

KEYWORDS:

Cataract complication; Descemet’s membrane; Descemet’s membrane detachment; Ophthalmic Viscosurgical Device (OVD); Phacoemulsification

PMID:
26586984
[PubMed – as supplied by publisher]
PMCID:
PMC4625420
Saudi J Ophthalmol. 2015 Oct-Dec;29(4):301-302. Epub 2015 Aug 3.

Spontaneously resolving descemet’s membrane detachment caused by an ophthalmic viscosurgical device during cataract surgery.

Abstract

We present a case of a central Descemet’s membrane detachment (DMD) induced by an Ophthalmic Viscosurgical Device during phacoemulsification surgery that resolved spontaneously, leaving a best spectacle corrected visual acuity of 20/20. The detachment was monitored with serial anterior segment optical coherence tomography images. Most cases of central DMD reported in the literature have been managed surgically to facilitate rapid visual recovery and minimize the risk of scarring. Our case adds to the literature in providing an alternative management strategy where surgical intervention may not be possible.

KEYWORDS:

Cataract complication; Descemet’s membrane; Descemet’s membrane detachment; Ophthalmic Viscosurgical Device (OVD); Phacoemulsification

PMID:
26586984
[PubMed – as supplied by publisher]
PMCID:
PMC4625420

Saudi J Ophthalmol. 2015 Oct-Dec;29(4):301-302. Epub 2015 Aug 3.

Spontaneously resolving descemet’s membrane detachment caused by an ophthalmic viscosurgical device during cataract surgery.

Abstract

We present a case of a central Descemet’s membrane detachment (DMD) induced by an Ophthalmic Viscosurgical Device during phacoemulsification surgery that resolved spontaneously, leaving a best spectacle corrected visual acuity of 20/20. The detachment was monitored with serial anterior segment optical coherence tomography images. Most cases of central DMD reported in the literature have been managed surgically to facilitate rapid visual recovery and minimize the risk of scarring. Our case adds to the literature in providing an alternative management strategy where surgical intervention may not be possible.

KEYWORDS:

Cataract complication; Descemet’s membrane; Descemet’s membrane detachment; Ophthalmic Viscosurgical Device (OVD); Phacoemulsification

PMID:
26586984
[PubMed – as supplied by publisher]
PMCID:
PMC4625420

Clear Corneal Phacovitrectomy with Posterior Capsulorhexis and IOL Implantation in Management of Selective Vitreoretinal Cases.

J Ophthalmol. 2015;2015:474072. Epub 2015 Oct 26.

Clear Corneal Phacovitrectomy with Posterior Capsulorhexis and IOL Implantation in Management of Selective Vitreoretinal Cases.

Abstract

Purpose. To describe our technique, clear corneal phacovitrectomy with posterior capsulorhexis (CCPV), for the management of selected posterior segment intraocular foreign body (IOFB), posteriorly dislocated lens fragments (PDLF), and proliferative diabetic retinopathy (PDR) cases. Methods. This was a single-center retrospective interventional case series. In 21 patients (21 eyes) we performed phacovitrectomy through three clear corneal tunnel incisions (CCTI) and posterior capsulorhexis to remove IOFB (n = 8), PDLF from the vitreous cavity after complicated phacoemulsification (n= 6), and vitreous hemorrhage and epiretinal membranes in PDR (n = 7). The procedure was completed with implantation of a hydrophobic acrylic IOL through the CCTI. Results. The mean visual acuity (logMAR) was 0.90 preoperative and improved to 0.26 over a mean follow-up of 8.7 months (range, 6-12 months). The intraocular lens was implanted into the capsular bag (n = 12) or onto the anterior capsule (n = 9). One PDR patient experienced an intraprocedural complication, hemorrhage from isolated fibrovascular adhesions. One IOFB patient developed apparent anterior proliferative vitreoretinopathy and required a repeat intervention. Conclusion. Selected vitreoretinal IOFB, PDLF, and PDR cases can be successfully managed by a combined surgical approach involving clear corneal phacovitrectomy with posterior capsulorhexis and implantation of an IOL, with good visual outcome and a low complication rate.

PMID:
26587281
[PubMed – as supplied by publisher]
PMCID

Abstract

Purpose. To describe our technique, clear corneal phacovitrectomy with posterior capsulorhexis (CCPV), for the management of selected posterior segment intraocular foreign body (IOFB), posteriorly dislocated lens fragments (PDLF), and proliferative diabetic retinopathy (PDR) cases. Methods. This was a single-center retrospective interventional case series. In 21 patients (21 eyes) we performed phacovitrectomy through three clear corneal tunnel incisions (CCTI) and posterior capsulorhexis to remove IOFB (n = 8), PDLF from the vitreous cavity after complicated phacoemulsification (n= 6), and vitreous hemorrhage and epiretinal membranes in PDR (n = 7). The procedure was completed with implantation of a hydrophobic acrylic IOL through the CCTI. Results. The mean visual acuity (logMAR) was 0.90 preoperative and improved to 0.26 over a mean follow-up of 8.7 months (range, 6-12 months). The intraocular lens was implanted into the capsular bag (n = 12) or onto the anterior capsule (n = 9). One PDR patient experienced an intraprocedural complication, hemorrhage from isolated fibrovascular adhesions. One IOFB patient developed apparent anterior proliferative vitreoretinopathy and required a repeat intervention. Conclusion. Selected vitreoretinal IOFB, PDLF, and PDR cases can be successfully managed by a combined surgical approach involving clear corneal phacovitrectomy with posterior capsulorhexis and implantation of an IOL, with good visual outcome and a low complication rate.

PMID:
26587281
[PubMed – as supplied by publisher]
PMCID

Micro-Bypass Implantation for Primary Open-Angle Glaucoma Combined with Phacoemulsification: 4-Year Follow-Up.

J Ophthalmol. 2015;2015:795357. Epub 2015 Oct 26.

Micro-Bypass Implantation for Primary Open-Angle Glaucoma Combined with Phacoemulsification: 4-Year Follow-Up.

Abstract

Purpose. To report the long-term follow-up results in patients with cataract and primary open-angle glaucoma (POAG) randomly assigned to cataract surgery combined with micro-bypass stent implantation or phacoemulsification alone. Methods. 36 subjects with cataract and POAG were randomized in a 1 : 2 ratio to either iStent implantation and cataract surgery (combined group) or cataract surgery alone (control group). 24 subjects agreed to be evaluated again 48 months after surgery. Patients returned one month later for unmedicated washout assessment. Results. At the long-term follow-up visit we reported a mean IOP of 15,9 ± 2,3 mmHg in the iStent group and 17 ± 2,5 mmHg in the control group (p = NS). After washout, a 14,2% between group difference in favour of the combined group was statistically significant (p = 0,02) for mean IOP reduction. A significant reduction in the mean number of medications was observed in both groups compared to baseline values (p = 0,005 in the combined group and p = 0,01 in the control group). Conclusion. Patients in the combined group maintained low IOP levels after long-term follow-up. Cataract surgery alone showed a loss of efficacy in controlling IOP over time. Both treatments reduced the number of ocular hypotensive medications prescribed. This trial is registered with: NCT00847158.

Abstract

Purpose. To report the long-term follow-up results in patients with cataract and primary open-angle glaucoma (POAG) randomly assigned to cataract surgery combined with micro-bypass stent implantation or phacoemulsification alone. Methods. 36 subjects with cataract and POAG were randomized in a 1 : 2 ratio to either iStent implantation and cataract surgery (combined group) or cataract surgery alone (control group). 24 subjects agreed to be evaluated again 48 months after surgery. Patients returned one month later for unmedicated washout assessment. Results. At the long-term follow-up visit we reported a mean IOP of 15,9 ± 2,3 mmHg in the iStent group and 17 ± 2,5 mmHg in the control group (p = NS). After washout, a 14,2% between group difference in favour of the combined group was statistically significant (p = 0,02) for mean IOP reduction. A significant reduction in the mean number of medications was observed in both groups compared to baseline values (p = 0,005 in the combined group and p = 0,01 in the control group). Conclusion. Patients in the combined group maintained low IOP levels after long-term follow-up. Cataract surgery alone showed a loss of efficacy in controlling IOP over time. Both treatments reduced the number of ocular hypotensive medications prescribed. This trial is registered with: NCT00847158.

Small-incision lenticule extraction (SMILE): outcomes of 722 eyes treated for myopia and myopic astigmatism.

Graefes Arch Clin Exp Ophthalmol. 2015 Nov 20. [Epub ahead of print]

Small-incision lenticule extraction (SMILE): outcomes of 722 eyes treated for myopia and myopic astigmatism.

Abstract

PURPOSE:

To study the outcomes of small-incision lenticule extraction (SMILE) for treatment of myopia and myopic astigmatism.

METHODS:

Retrospective study of patients treated for myopia or myopic astigmatism with SMILE, using a VisuMax® femtosecond laser (Carl Zeiss Meditec, Jena, Germany), at the Department of Ophthalmology, Odense University Hospital, Odense, Denmark. Inclusion criteria were corrected distance visual acuity (CDVA) of 20/25 or better before surgery and no ocular conditions other than myopia up to -10.00 diopters (D) with astigmatism up to 3.00 D.

RESULTS:

Of the 729 treatments, 722 were included. The spherical equivalent (SE) refraction averaged -6.82 ± 1.66 diopters (D) before surgery. After 3 months, 88 % of eyes were within ±0.50 D of the intended refraction, whilst 98 % were within ±1.00 D. The mean difference between attempted and achieved SE refraction at 3 months after surgery was -0.06 ± 0.01 D (range: -1.25 to 1.25 D). In eyes with emmetropia as target refraction (n = 362), 63 % had uncorrected distance visual acuity (UDVA) of 20/25 or better 1 day after surgery, rising to 83 % at 3 months after surgery. The average gain in CDVA from before surgery to 3 months after surgery was 0.07 ± 0.03 (logMAR). However, 12 eyes (1.6 %) lost 2 or more lines of CDVA from before surgery to 3 months postoperatively. Simultaneous treatment of up to 3.00 D of astigmatism was not associated with less predictable refractive outcomes.

CONCLUSIONS:

In the short term, SMILE seemed predictable, efficient, and safe for treatment of myopia and myopic astigmatism.

KEYWORDS:

Femtosecond laser; Myopia; Small-incision lenticule extraction

An analysis of factors influencing quality of vision after big-bubble deep anterior lamellar keratoplasty in keratoconus.

Am J Ophthalmol. 2015 Nov 14. pii: S0002-9394(15)00706-0. doi: 10.1016/j.ajo.2015.11.018. [Epub ahead of print]

An analysis of factors influencing quality of vision after big-bubble deep anterior lamellar keratoplasty in keratoconus.

Abstract

PURPOSE:

To identify causes of reduced visual acuity and contrast sensitivity after big-bubble deep anterior lamellar keratoplasty (DALK) in keratoconus.

DESIGN:

Prospective interventional case series.

METHODS:

This study included 36 eyes in 36 patients with keratoconus who underwent DALK using the big-bubble technique. A bare Descemet membrane was achieved in all cases. Univariate analyses and multiple linear regression were used to investigate recipient-, donor-, and postoperative-related variables capable of influencing the postoperative quality of vision, including best-spectacle corrected visual acuity (BSCVA) and contrast sensitivity.

RESULTS:

The mean patient age was 27.7±6.9 years old, and the patients were followed for 24.6±15.1 months postoperatively. The mean postoperative BSCVA was 0.17±0.09 LogMAR. Postoperative BSCVA ≥ 20/25 was achieved in 14 eyes (38.9%), whereas a BSCVA of 20/30, 20/40, or 20/50 was observed in 15 eyes (41.7%), six eyes (16.6%), and one eye (2.8%), respectively. Preoperative vitreous length was significantly associated with postoperative BSCVA (β=0.02, P=0.03). Donor-recipient interface reflectivity significantly influenced scotopic (β=-0.002, P=0.04) and photopic (β=-0.003, P=0.02) contrast sensitivity. The root mean square of tetrafoil was significantly negatively associated with scotopic (β=-0.25, P=0.01) and photopic (β=-0.23, P=0.04) contrast sensitivity. Recipient age, keratoconus severity, donor-related variables, recipient trephination size, and graft and recipient bed thickness were not significantly associated with postoperative visual acuity or contrast sensitivity.

CONCLUSION:

Large vitreous length, higher-order aberrations, and surgical interface haze may contribute to poor visual outcomes after big-bubble DALK in keratoconus.

RESULTS:

The mean patient age was 27.7±6.9 years old, and the patients were followed for 24.6±15.1 months postoperatively. The mean postoperative BSCVA was 0.17±0.09 LogMAR. Postoperative BSCVA ≥ 20/25 was achieved in 14 eyes (38.9%), whereas a BSCVA of 20/30, 20/40, or 20/50 was observed in 15 eyes (41.7%), six eyes (16.6%), and one eye (2.8%), respectively. Preoperative vitreous length was significantly associated with postoperative BSCVA (β=0.02, P=0.03). Donor-recipient interface reflectivity significantly influenced scotopic (β=-0.002, P=0.04) and photopic (β=-0.003, P=0.02) contrast sensitivity. The root mean square of tetrafoil was significantly negatively associated with scotopic (β=-0.25, P=0.01) and photopic (β=-0.23, P=0.04) contrast sensitivity. Recipient age, keratoconus severity, donor-related variables, recipient trephination size, and graft and recipient bed thickness were not significantly associated with postoperative visual acuity or contrast sensitivity.

CONCLUSION:

Large vitreous length, higher-order aberrations, and surgical interface haze may contribute to poor visual outcomes after big-bubble DALK in keratoconus.

Copyright © 2015 Elsevier Inc. All rights reserved.

Analysis of the changes in keratoplasty indications and preferred techniques.

PLoS One. 2014 Nov 11;9(11):e112696. doi: 10.1371/journal.pone.0112696. eCollection 2014.

Analysis of the changes in keratoplasty indications and preferred techniques.

Abstract

BACKGROUND:

Recently, novel techniques introduced to the field of corneal surgery, e.g. Descemet membrane endothelial keratoplasty (DMEK) and corneal crosslinking, extended the therapeutic options. Additionally contact lens fitting has developed new alternatives. We herein investigated, whether these techniques have affected volume and spectrum of indications of keratoplasties in both a center more specialized in treating Fuchs’ dystrophy (center 1) and a second center that is more specialized in treating keratoconus (center 2).

METHODS:

We retrospectively reviewed the waiting lists for indication, transplantation technique and the patients’ travel distances to the hospital at both centers.

RESULTS:

We reviewed a total of 3778 procedures. Fuchs’ dystrophy increased at center 1 from 17% (42) to 44% (150) and from 13% (27) to 23% (62) at center 2. In center 1, DMEK increased from zero percent in 2010 to 51% in 2013. In center 2, DMEK was not performed until 2013. The percentage of patients with keratoconus slightly decreased from 15% (36) in 2009 vs. 12% (40) in 2013 in center 1. The respective percentages in center 2 were 28% (57) and 19% (51). In both centers, the patients’ travel distances increased.

CONCLUSIONS:

The results from center 1 suggest that DMEK might increase the total number of keratoplasties. The increase in travel distance suggests that this cannot be fully attributed to recruiting the less advanced patients from the hospital proximity. The increase is rather due to more referrals from other regions. The decrease of keratoconus patients in both centers is surprising and may be attributed to optimized contact lens fitting or even to the effect corneal crosslinking procedure.

RESULTS:

We reviewed a total of 3778 procedures. Fuchs’ dystrophy increased at center 1 from 17% (42) to 44% (150) and from 13% (27) to 23% (62) at center 2. In center 1, DMEK increased from zero percent in 2010 to 51% in 2013. In center 2, DMEK was not performed until 2013. The percentage of patients with keratoconus slightly decreased from 15% (36) in 2009 vs. 12% (40) in 2013 in center 1. The respective percentages in center 2 were 28% (57) and 19% (51). In both centers, the patients’ travel distances increased.

CONCLUSIONS:

The results from center 1 suggest that DMEK might increase the total number of keratoplasties. The increase in travel distance suggests that this cannot be fully attributed to recruiting the less advanced patients from the hospital proximity. The increase is rather due to more referrals from other regions. The decrease of keratoconus patients in both centers is surprising and may be attributed to optimized contact lens fitting or even to the effect corneal crosslinking procedure.

Corneal transplantation at an ophthalmological referral center in Colombia: indications and techniques (2004-2011).

Open Ophthalmol J. 2013 Jul 17;7:30-3. doi: 10.2174/1874364101307010030. Print 2013.

Corneal transplantation at an ophthalmological referral center in Colombia: indications and techniques (2004-2011).

Abstract

PURPOSE:

To analize changing trends in indications and surgical techniques of corneal transplantation at an ophthalmological tertiary referral center in Colombia over a 7 year period.

METHODS:

A retrospective analysis was performed of medical records from patients who underwent corneal transplantation surgeries at Fundación Oftalmológica de Santander (FOSCAL) in Bucaramanga, Colombia, between August 2004 and August 2011.

RESULTS:

During this period from a total of 450 corneal transplants performed, we had access to 402 medical records (89.4%). The patients’ mean age was 55. Leading indications were: pseudophakic/aphakic bullous kerathopathy (PBK/ABK) (34.6%), corneal scar (15.7%), active infectious keratitis (14.4%) and keratoconus (12.7%). During the first period (2004-2007) PBK/ABK was the leading indication, followed by stromal opacities and keratoconus. During the second period (2008-2011) PBK/ABK remained the leading indication. Infectious keratitis, however, became the second most common indication. Stromal opacities and keratoconus, moved to third and fourth, respectively. All transplants performed in the first period (2004-2007) were penetrating keratoplasties. In the second period (2008-2011) 18.7% of the procedures were performed using the Descemet’s stripping automated endothelial keratoplasty technique (DSAEK).

CONCLUSIONS:

Similar to other international results, PBK/ABK was the leading indication for corneal transplantation at our institution. Keratoconus is becoming a less common indication for keratoplasty in our institution. Infectious keratitis remains a frequent indication for corneal transplantationin this geographical area. In our institution we started performing DSAEK in 2009, and it is emerging as the procedure of choice in corneal diseases that involve only the endothelial layers.

CONCLUSIONS:

Similar to other international results, PBK/ABK was the leading indication for corneal transplantation at our institution. Keratoconus is becoming a less common indication for keratoplasty in our institution. Infectious keratitis remains a frequent indication for corneal transplantationin this geographical area. In our institution we started performing DSAEK in 2009, and it is emerging as the procedure of choice in corneal diseases that involve only the endothelial layers.

KEYWORDS:

Corneal transplantation; DSAEK; endothelial keratoplasty; lamellar keratoplasty; penetrating keratoplasty