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State of the Art of Corneal Transplantation

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: closed (20 February 2023) | Viewed by 5649

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Special Issue Editors

Dr. Uri Elbaz

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Guest Editor

1. Department of Ophthalmology, Rabin Medical Center, Schneider Children's Medical Center, Petach Tikva, Israel
2. Department of Ophthalmology, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Interests: corneal diseases; corneal transplantation; corneal dystrophies; dry eyes; blepharokeratoconjunctivitis
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Dr. Asaf Achiron

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Guest Editor

Bristol Eye Hospital, Bristol, UK
Interests: ophthalmology; corneal diseases; corneal transplantation; pseudo-exfoliation (PXF); intra-operative floppy iris syndrome (IFIS)

Dr. Asim Ali

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Guest Editor

Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
Interests: ophthalmology; corneal diseases; corneal transplantation; glaucoma; pediatric cataract

Dr. Kamiar Mireskandari

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Guest Editor

Department of Ophthalmology and Vision Sciences, Hospital for Sick Children and University of Toronto, Toronto, ON M5S 1A8, Canada
Interests: corneal transplantation; external diseases; cataract; glaucoma; retinopathy of prematurity and strabismus

Special Issue Information

Dear Colleagues,

Corneal transplantation has dramatically evolved over the last two decades. It is beneficial to patients and clinicians to shift from a one-fit-all transplantation (penetrating keratoplsty, PKP) to custom fit corneal grafting adjusted to a specific indication. Anterior lamellar diseases, such as corneal scars, keratoconus and inflammatory conditions, are most likely treated with anterior lamellar keratoplasty, i.e, deep anterior lamellar keratoplasty (DALK), whereas posterior lamellar pathologies, mostly Fuchs’ endothelial dystrophy (FED) and posterior polymorphous corneal dystrophy (PPCD), are treated with posterior lamellar keratoplasty, namely Descemet’s stripping automated endothelial keratoplsty (DSAEK) and Descemet’s membrane endothelial keratoplsty (DMEK). This explains the drastic decrease in the number of PKPs performed in recent years, with a shifting trend towards lamellar keratoplasty. Studies have shown that PKPs accounted for 95% of all corneal transplants performed before 2004, whereas this portion decreased to less then 40% of all the new transplants performed in the recent years. Conversely, the rate of lamellar keratoplasy is steadily increasing. Nowadays, the deficiencies and injuries of limbal stem cells are treated with some success using several surgical techniques, which include simple limbal epithelial transplantation (SLET) and cultured oral mucosal epithelial transplantation (COMET). Despite these remarkable surgical advancements, there is still the opportunity for prolific research to be conducted in the field of corneal transplantation.
“The State of the Art of Corneal Transplantation” is a Special Issue that focuses on presenting both original research and review articles on the recent developments in corneal transplantation surgery.

Dr. Uri Elbaz
Dr. Asaf Achiron
Dr. Asim Ali
Dr. Kamiar Mireskandari
Guest Editors

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Keywords

Descemet Membrane Endothelial Keratoplasty (DMEK)
Descemet Stripping Automated Endothelial Keratoplasty (DSAEK)
Deep Anterior Lamellar Keratoplasty (DALK)
Penetrating Keratoplasty (PKP)
Congenital Corneal Opacity (CCO)
Keratolimbal Allograft (KLAL)
Conjunctival Limbal Autograft (CLAU)
Keratoconus

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Research

11 pages, 2809 KiB

Open AccessArticle

Clinical Outcomes of the Intraocular Lens Injector and Busin Glide for Descemet Stripping Automated Endothelial Keratoplasty in Patients with Iridocorneal Endothelial Syndrome

by Saiqing Li, Zihao Liu, Binjia Sun, Zelin Zhao, Haiou Wang, Qinxiang Zheng and Wei Chen

J. Clin. Med. 2023, 12(5), 1856; https://doi.org/10.3390/jcm12051856 - 26 Feb 2023

Cited by 2 | Viewed by 1771

Abstract

Purpose: To report the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) performed in iridocorneal endothelial (ICE) syndrome patients using the intraocular lens injector (injector), in comparison with those using the Busin glide. Methods: In this retrospective, interventional comparative study, we evaluated the outcomes of DSAEK performed using the injector (n = 12) or the Busin glide (n = 12) for patients with ICE syndrome. Their graft position and postoperative complications were recorded. Their best-corrected visual acuity (BCVA) and endothelial cell loss (ECL) were monitored over a 12-month follow-up period. Results: DSAEK was conducted successfully in the 24 cases. The BCVA improved from the preoperative 0.99 ± 0.61 to 0.36 ± 0.35 at 12 months after operation (p < 0.001), with no significant difference between the two groups (the injector group and the Busin group) (p = 0.933). ECL at 1 month after DSAEK was 21.80 ± 15.01% in the injector group, which was significantly lower than 33.69 ± 9.75% of the Busin group (p = 0.031). No surgery-related complications were observed in the 24 cases intraoperatively or postoperatively except that one case suffered from postoperative graft dislocation, without statistical difference between the two groups. Conclusions: At 1 month after surgery, the use of graft injector for delivering DSAEK-based endothelial graft may cause significantly less endothelial cell damage than the pull-through technique used in the application of Busin glide. The injector allows safe endothelial graft delivery without the need of anterior chamber irrigation, which increases the ratio of successful graft attachment. Full article

(This article belongs to the Special Issue State of the Art of Corneal Transplantation)

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10 pages, 1253 KiB

Open AccessArticle

Comparison of Microbial Sampling Sites and Donor-Related Factors on Corneal Graft Contamination

by Yu-Jen Wang, Ko-Chiang Sung, Wei-Chen Lin and Fu-Chin Huang

J. Clin. Med. 2022, 11(21), 6236; https://doi.org/10.3390/jcm11216236 - 22 Oct 2022

Cited by 1 | Viewed by 1396

Abstract

Grafts used for corneal donation should be sterile to avoid transplantation failure and secondary infection. However, there are no clear and globally accepted specifications from eye banks on microbial sampling sites. The objective of this study was to analyze microbial contamination of corneal grafts collected from different sampling sites. We found that the contamination rates and strain compositions significantly differed at different sampling sites. To clarify the effect of the microbial sampling site on corneal graft contamination, microbial sampling was conducted using 30 corneal grafts at the extraocular and intraocular sides of the graft in 2020 from the National Eye Bank of Taiwan. Microbial contamination significantly differed (p < 0.05) between the different sampling sites on the graft according to McNemar’s test. Although the two sampling sites showed the same specificity (33.33%), the sensitivity of sampling on the extraocular side (82.35%) was higher than that on the intraocular side (17.65%) of the graft. Donor-associated factors, including the cause of death, operating place, and cold compression, were analyzed using chi-square statistics, which revealed no significant differences in microbial contamination. Thus, our data provide evidence for the microbial sampling site of donated grafts and clear specifications for maintaining the quality of corneal grafts. Full article

(This article belongs to the Special Issue State of the Art of Corneal Transplantation)

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10 pages, 2448 KiB

Open AccessArticle

Repeated Femtosecond Laser-Assisted Astigmatic Keratotomies in Post-Keratoplasty Eyes

by Nadav Levinger, Shmuel Levinger, Nir Erdinest, Asaf Achiron, Naomi London, Omer Trivizki, Eliya Levinger and Irina S. Barequet

J. Clin. Med. 2022, 11(14), 4221; https://doi.org/10.3390/jcm11144221 - 20 Jul 2022

Cited by 1 | Viewed by 1652

Abstract

Visual rehabilitation after a keratoplasty is often compromised due to high amounts of residual astigmatism. Femtosecond laser-assisted astigmatic keratotomy (FLAK) is gaining popularity in decreasing this astigmatism. Though one set of two incisions suffices in most cases, sometimes the treatment proves insufficient and additional treatment is required. This case series evaluates the outcomes in patients who underwent two consecutive FLAK sets to correct post-keratoplasty residual astigmatism. All repeated FLAK cases performed on post-keratoplasty eyes were reviewed in a high-volume clinic as a non-comparative retrospective case series. The data extracted include the procedure parameters, time between procedures, refraction including sphere, astigmatism, spherical equivalent (SE), and uncorrected and best-spectacle-corrected distance visual acuity (UDVA, BSDVA, respectively). Eleven eyes of eleven patients aged 25.5 ± 10 treated with more than one FLAK procedure were identified. The average follow-up time was 6 months after the first FLAK and 24 ± 10 months after the second. The second FLAK was performed six months after the first. The preoperative mean astigmatism was −9.59 ± 2.36 D. At the final follow-up, the mean astigmatism decreased to −5.38 ± 1.79 D (p = 0.001). Repeated FLAK procedures achieved a significant and stable reduction of astigmatism in post-keratoplasty eyes. This procedure shows safety and effectivity in these complex eyes and may prevent the need for a further keratoplasty. Full article

(This article belongs to the Special Issue State of the Art of Corneal Transplantation)

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