Purpose:Keratoplasty patients require regular and timely follow-ups. During this COVID-19 pandemic which restricted global travel, we developed a novel real-time, hybrid teleophthalmology approach to comanage international keratoplasty patients between Singapore and Indonesia.Methods:A retrospective consecutive observational study of 72 corneal patients (63 were postkeratoplasty) who attended a virtual corneal clinic (VCC) between June 2020 and April 2021 at JEC Eye Hospitals (JEC) in Jakarta, Indonesia. ZOOM Meeting software (Zoom Video Communication Inc, San Jose, CA) was used to simultaneously connect the Singapore corneal specialist at Eye & Cornea Surgeons (ECS), Singapore, using a real-time approach. Clinical examinations included full panels of video-linked corneal, glaucoma, and retinal imaging and investigations performed before real-time video-linked slit-lamp examination, with immediate clinical decision making between corneal specialists and patients.Results:VCC enabled effective real-time clinical evaluation and collaborative clinical decisions, with full patient interaction, with the aim of maintenance of graft clarity, visual function, and management of comorbidities—a) topical and systemic medications were adjusted in 79.2% of patients; b) further referrals to glaucoma, retinal, and oculoplastic subspecialists were made in 16.6% of cases; c) additional adjunctive surgical procedures were performed at JEC in 6.9% cases; and d) government permission was obtained for 4 patients (5.6%) to fly to Singapore for urgent corneal surgery.Conclusions:The virtual corneal clinic is a novel real-time hybrid teleophthalmology approach which is effective in the comanagement of international keratoplasty patients and represents the advances in ophthalmic telemedicine.

DALK surgery after DSAEK can improve vision in cases of residual host scarring and treat host corneal infection, while avoiding open-sky surgery and sparing a healthy endothelial graft.

The ocular surface is formed by three component tissues: The cornea, conjunctiva, and limbus all play an important role in keeping a good and clear corneal graft. As part of non-immunological reactions, glaucoma and ocular surface disorders can increase the possibility of corneal graft failure. For that reason, maintaining a healthy and moist ocular surface, depends on an intimate relationship between healthy ocular surface epithelia, the tear film, and the eyelid, which will all increase corneal graft survival. A moist conjunctiva composed of lymphatic tissue as our defense mechanism against infection, will keep the cornea avascular, remaining crystal clear, dehydrated, and protected. Ocular surface epithelium cannot survive without tears. To specified, each component tissue that forms the ocular surface is equally important. Several previous studies revealed that dry eye disease as a form of ocular surface disorders (OSD), can lead to graft rejection. To our knowledge, there are two conditions that cause dry eye syndrome. It can be caused by lipid tear deficiency or aqueous tear deficiency. The severity of dry eye also ranges widely with some mild inflammatory processes leading to severe chronic conditions (i.e., cicatrizing conjunctivitis) that are known to be an absolute contraindication for total or full penetrating keratoplasty. The basic immunological mechanism of dry eye, as one of the most forms of ocular surface disorders that altered corneal graft survival will be discussed specifically in this chapter.

Purpose : Corneal disorders leading to corneal blindness was one of the major causes for blindness worldwide. This retrospective study was done to report the indications for corneal transplantation and also the latest surgical technique between lamellar and penetrating keratoplasty at JEC Hospital, Jakarta Indonesia from 2014 to 2018. Methods : Records of all patients who underwent penetrating and lamellar keratoplasties at our hospital between 2014 and 2018 were reviewed retrospectively. Patient demographic data such as age and gender, together with indications and surgical technique of corneal transplantation were recorded and analysed. Results : Pseudophakic bullous keratopathy, corneal scarring post infection, and corneal dystrophy were the most common indications for corneal transplantation in our centre (33.91%; 28%; 16.63%; respectively). In 2014, corneal ulcer was one of the leading causes for complete corneal transplantation (12.5%) but its incidence was decreasing each year. 66.55% of procedures performed were penetrating keratoplasty. However, the shift from penetrating to lamellar procedures such as DSAEK increases significantly since 2007 and even more increased by 2 times within the last 5 years (15.27%; 35%; respectively). Conclusion : The number of keratoplasties in JEC has increased from 2014 to 2018. Since 2007, posterior lamellar keratoplasties have increased and began to create some shift from penetrating to lamellar since then. There was a constant increase number of DSAEK due to donor availability from the new eye bank in 2017. The shorter recovery time after DSAEK seems to contribute to the trend toward earlier operative intervention in corneal endothelial disease. The leading indications for DSAEK was bullous keratopathy.