Approaches toward enhancing survival probability following deep anterior lamellar keratoplasty

Feizi, Sepehr; Azari, Amir A.

doi:10.1177/2515841420913014

Cited by 6 publications

(5 citation statements)

References 137 publications

(225 reference statements)

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“…Corneal grafts can also be a source of HSK infection if not properly screened[ 224 ]. With a global shortage of available viable cornea graft tissue, Li et al [ 225 ] demonstrated that porcine corneal tissue is a good option for human corneal tissue[ 225 ], Recurrent HSK has been implicated in Deep Anterior Lamellar Keratoplasty failure[ 226 ]. It is therefore important to differentiate between HSV-linked endotheliitis and actual graft rejection[ 227 ].…”

Section: Recurrent Herpes Simplex Keratitis: Clinical Features and Pr...mentioning

confidence: 99%

Herpes simplex keratitis: A brief clinical overview

Musa,

Enaholo,

Aluyi-Osa

et al. 2024

World J Virol

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The aim of our minireview is to provide a brief overview of the diagnosis, clinical aspects, treatment options, management, and current literature available regarding herpes simplex keratitis (HSK). This type of corneal viral infection is caused by the herpes simplex virus (HSV), which can affect several tissues, including the cornea. One significant aspect of HSK is its potential to cause recurrent episodes of inflammation and damage to the cornea. After the initial infection, the HSV can establish a latent infection in the trigeminal ganglion, a nerve cluster near the eye. The virus may remain dormant for extended periods. Periodic reactivation of the virus can occur, leading to recurrent episodes of HSK. Factors triggering reactivation include stress, illness, immunosuppression, or trauma. Recurrent episodes can manifest in different clinical patterns, ranging from mild epithelial involvement to more severe stromal or endothelial disease. The severity and frequency of recurrences vary among individuals. Severe cases of HSK, especially those involving the stroma and leading to scarring, can result in vision impairment or even blindness in extreme cases. The cornea's clarity is crucial for good vision, and scarring can compromise this, potentially leading to visual impairment. The management of HSK involves not only treating acute episodes but also implementing long-term strategies to prevent recurrences and attempt repairs of corneal nerve endings via neurotization. Antiviral medications, such as oral Acyclovir or topical Ganciclovir, may be prescribed for prophylaxis. The immune response to the virus can contribute to corneal damage. Inflammation, caused by the body's attempt to control the infection, may inadvertently harm the corneal tissues. Clinicians should be informed about triggers and advised on measures to minimize the risk of reactivation. In summary, the recurrent nature of HSK underscores the importance of both acute and long-term management strategies to preserve corneal health and maintain optimal visual function.

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Section: Recurrent Herpes Simplex Keratitis: Clinical Features and Pr...mentioning

confidence: 99%

Herpes simplex keratitis: A brief clinical overview

Musa,

Enaholo,

Aluyi-Osa

et al. 2024

World J Virol

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“…Endothelial rejections do not occur as the recipient retains their own Descemet's membrane and endothelium, but epithelial, subepithelial, and stromal reactions are still possible [77,78,143]. DALK rejection rates range from 0 to 21.2% with up to 10 years of follow-up (Table 2) [45,46 ▪ ,64 ▪ ,65,66,68,77–81,83,84,134 ▪▪ ,140 ▪▪ ,144]. Rejection risk in DALK is highest during the first year and subsides as the host epithelial cells and keratocytes repopulate the donor tissue but several studies report an average time-to-rejection between 1 and 2 years [35,45,65,77–79,84,144].…”

Section: Understanding Rejection Riskmentioning

confidence: 99%

“…Data from [35,38,59,77,78,92,95,97,112,131–133,134 ▪▪ ,135 ▪ –137 ▪ ,138 ▪▪ ]. DALK, deep anterior lamellar keratoplasty; DMEK, Descemet's membrane endothelial keratoplasty; DSAEK, Descemet's stripping endothelial keratoplasty; HSV-1, herpes simplex virus 1; IOL, intraocular lens; PKP, penetrating keratoplasty.aIncludes bullous keratopathy, severe dry eye disease, ocular mucous membrane pemphigoid, Steven–Johnson syndrome, chemical injury.…”

Section: Understanding Rejection Riskmentioning

confidence: 99%

Impact of vaccination on keratoplasty

Dugan

2022

Current Opinion in Ophthalmology

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Purpose of reviewCorneal graft rejection has been reported after coronavirus disease 2019 (COVID-19) vaccination. The purpose of this review is to evaluate the literature regarding corneal graft rejection after vaccination, including rejection rates and risk factors. We aim to create a framework to identify patients who are at higher risk for graft rejection and may warrant consideration of prophylactic interventions.Recent findingsGraft rejection has been reported following administration of mRNA, viral vector, and inactivated whole-virion COVID-19 vaccines. Most cases had additional risk factors associated with rejection. Vaccination increases circulation of proinflammatory cytokines, CD4+ and CD8+ T-cell responses, and antispike neutralizing antibody, all of which may contribute to graft rejection. Two prospective studies have found no relationship between recent vaccination and rejection but 20% of cornea specialists report to have seen a vaccine-associated rejection and 22% recommend delaying vaccination in certain circumstances. Many specialists recommend prophylactic topical corticosteroids before and after vaccination to mitigate rejection risk but there is no evidence to support this practice on a wider scale.SummaryOur framework identified 96.8% of penetrating keratoplasty patients with vaccine-associated rejection as higher risk. Further research is needed in order to develop evidence-based guidelines.

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“…[ 2 ] Conventionally, penetrating keratoplasty (PK) served as the gold standard for addressing various corneal pathologies, including KC, demonstrating commendable graft survival rates. [ 3 ] However, PK was marred by complications, including the risk of endothelial rejection, endothelial cell loss, and various postoperative issues. [ 4 ]…”

Section: Introductionmentioning

confidence: 99%

Main issues in deep anterior lamellar keratoplasty: A systematic narrative review

Niazi,

Barrio,

Doroodgar

et al. 2024

Taiwan Journal of Ophthalmology

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Deep anterior lamellar keratoplasty (DALK) has emerged as a transformative approach in managing corneal pathologies, notably keratoconus (KC), providing a viable alternative to penetrating keratoplasty (PK). This systematic review explores the intricacies of DALK, comparing its preoperative, intraoperative, and postoperative considerations with PK. Extensive literature searches revealed a wealth of data regarding DALK’s advantages and challenges, with an emphasis on graft survival, visual outcomes, and complications. In the preoperative phase, DALK showcases its versatility, catering to a wide spectrum of patients, including those with KC and ocular surface disorders. Intraoperatively, it offers innovative techniques to address emphysema, bubble formation, and Descemet’s membrane perforation, all while maintaining a strong focus on patient-centered outcomes. Postoperatively, DALK’s lower rejection rates and decreased complications underscore its potential superiority over PK, although unique challenges such as graft failure from nonimmunologic factors demand vigilant management. This comprehensive review not only serves as a valuable resource for ophthalmic surgeons but also sheds light on the evolving landscape of corneal transplantation, highlighting DALK’s role as a transformative force in the field.

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Approaches toward enhancing survival probability following deep anterior lamellar keratoplasty

Cited by 6 publications

References 137 publications

Herpes simplex keratitis: A brief clinical overview

Herpes simplex keratitis: A brief clinical overview

Impact of vaccination on keratoplasty

Main issues in deep anterior lamellar keratoplasty: A systematic narrative review

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