We successfully utilized one donor cornea for three patients: firstly, a crescentic lamellar keratoplasty for Terrien’s marginal degeneration; secondly, Descemet’s membrane endothelial keratoplasty for Fuchs endothelial dystrophy; and finally, deep anterior lamellar keratoplasty for an advanced keratoconus patient. All three grafts were prepared during the first surgery, and the other two grafts were preserved and used on another day. Patients were followed up for 1 year, and all have good visual outcomes with stable grafts. Our first patient underwent a novel combined surgery of tight sutures for ectasia reduction that is usually performed at an earlier stage, with tissue augmentation using a lamellar graft meant for the later stage of the disease. With a successful outcome of up to 1-year follow-up, this technique can be considered in other suitable peripheral ectasias in the future. By sharing our experience, we hope that corneal surgeons and their patients at large will benefit.
We report six eyes of five patients with keratoglobus who underwent limbal-sparing lamellar keratoplasty (LSLK) with 7 years of follow-up. In two patients’ three eyes, it was congenital and the rest had acquired keratoglobus from pellucid marginal degeneration combined with keratoconus. In LSLK, the peripheral corneal epithelium is dissected to include the stem cells and reflected along with conjunctival peritomy. The host cornea is de-epithelialized, stromal irregularities dissected, and then a corneoscleral graft denuded of Descemet’s membrane is anchored to a scleral ledge fashioned. Postoperatively, all received adequate tectonic support, and except for one posttrauma eye, the rest improved visually.
A young diabetic male patient presented with a ring infiltrate and hypopyon of 1-day onset in the left eye. Though we suspected acanthamoeba keratitis, the initial smear report showed fungal filaments. So, we started dual topical with systemic antifungals. On day 3, the ring was filled with a reddish-brown infiltrate, and the culture grew pale-gray fungal colonies. A clinical diagnosis of dematiaceous fungi was made, commonly observed at our clinic is Curvularia, which responds to the chosen treatment combination. Due to clinical worsening, we considered therapeutic penetrating keratoplasty that got delayed until diabetic control. With further worsening, we re-scraped with a day off medication and performed confocal microscopy and polymerase chain reaction (PCR). The organism was identified as Cladorrhinum bulbillosum from the DNA extract from colonies grown in blood agar when subjected to PCR-based sequencing carried out in the ABI 3130 genetic analyzer. The patient underwent therapeutic penetrating keratoplasty on day 11.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.