Argon laser iridotomy-induced bullous keratopathy--a growing problem in Japan

Ang, Leonard P. K.; Higashihara, Hisayo; Sotozono, Chie; Shanmuganathan, Vijay; Dua, Harminder S; Tan, Donald; Kinoshita, Shigeru

doi:10.1136/bjo.2007.120261

Cited by 76 publications

(60 citation statements)

References 17 publications

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“…But in this study, we only found LI-related BK in four eyes. We considered that the reason was that Nd: YAG laser or sequential argon-YAG laser rather than argon laser was used to perform iridotomy, since it was reported previously that argon laser iridotomy was more likely to induce BK than YAG laser iridotomy [10].…”

Section: Dear Editormentioning

confidence: 99%

Analysis of causes of bullous keratopathy in East China: a 10-year retrospective study

Wang

et al. 2011

Graefes Arch Clin Exp Ophthalmol

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Dear EditorBullous keratopathy (BK) leads to decreased corneal transparency and ultimate loss of visual acuity [1]. According to the previous literatures, BK was one of the leading reasons for corneal transplantation [2][3][4][5], and Fuchs' dystrophy was most commonly seen in the etiology of BK [1-3]. However, Fuchs' dystrophy wasn't the leading cause of BK in China. So we performed a retrospective study to explore the causes of BK in East China in the past 10 years.Medical records of inpatients diagnosed as BK treated in the Eye & ENT Hospital of Fudan University, one of the key eye centers in East China, between 1999 to 2008 were retrospectively reviewed, including demographic characteristics, cause of BK, preoperative conditions, associated disorders and surgery performed.A total of 249 eyes of 214 patients were reviewed in this study, composed of 85 females (39.7%) and 129 males (60.3%) aged from 13 to 86 years (mean 57.15±17.4 years). The leading cause of BK was intraocular surgery (130/249, 52.2%), among which 72.7% (94/130) of eyes were cataract surgery. The following reasons were glaucoma (50/249, 20.1%), ocular trauma (31/249, 12.4%), graft failure (13/ 249, 5.2%), herpes simplex keratitis (13/249, 5.2%), Fuchs' dystrophy (8/249, 3.2%) and laser iridotomy (LI) (4/249, 1.6%). Details of etiology are described in Table 1.As for the interval study, the percentage of BK caused by cataract surgery decreased gradually. In contrast, that induced by ocular trauma increased significantly, and the incidence of glaucoma-related BK was relatively steady in the past 10 years, shown in Fig. 1.Intraocular surgery was the leading cause of BK in East China, accounting for one half of the total cases. With the popularization of cataract surgery in China in the decade, the incidence of pseudophakic and aphakic bullous keratopathy increased dramatically. Interestingly, the percentage of BK due to cataract surgery showed an obvious decreasing trend in the recent 5 years, which may probably be attributed to better surgical techniques, improved intraocular lenses, and proper use of viscoelastics. Our result is similar to other researches [1,2,6].Another finding of this study was that glaucoma caused 20.1% of BK in total cases. Further analysis showed that only six eyes with primary glaucoma developed BK, whereas 44 eyes were caused by secondary glaucoma, suggesting that the risk to develop BK increased dramatically once glaucoma coexisted with other ocular diseases such as ocular trauma and surgery.Even when not coexisting with glaucoma, ocular trauma still acted as the third leading cause of BK in this study. Patients of these cases were mainly young or middle-aged, acting as main workers in the families, which reminded us that much more attention should be paid to the trauma. LI used to be a recommended treatment for affected and contralateral eyes in acute angle-closure glaucoma [7]. Shimazaki et al. [8] reported a strikingly large number of LI-related BK in Japan. They supposed that the difference in the rate of LI-relat...

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Section: Dear Editormentioning

confidence: 99%

Analysis of causes of bullous keratopathy in East China: a 10-year retrospective study

Wang

et al. 2011

Graefes Arch Clin Exp Ophthalmol

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“…Although Fuchs endothelial dystrophy is the leading cause of bullous keratopathy in Western countries, LI-BK is one of the most common causative diseases in Japan. 2,8,27 Eyes with LI-BK are typically complicated with a shallow anterior chamber and dense cataract. Shortage of donor corneal supply in Japan results in advanced corneal edema occurring in many cases.…”

Section: Dalk Versus Pkpmentioning

confidence: 99%

How Much Progress Has Been Made in Corneal Transplantation?

Shimazaki

Ishii

Shinzawa

et al. 2015

Cornea

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To assess the benefits of component lamellar corneal surgery, we investigated the surgical outcomes of deep anterior lamellar keratoplasty (DALK) for keratoconus and Descemet stripping automated endothelial keratoplasty (DSAEK) for laser iridotomy-induced bullous keratopathy (LI-BK). The results were compared with the surgical outcomes of penetrating keratoplasty (PKP). Seventy-nine eyes with keratoconus treated with DALK and 81 eyes with LI-BK treated with DSAEK were studied, and the graft clarity rate, best spectacle-corrected visual acuity, endothelial cell density (ECD), and surgical complications were compared with 273 eyes with keratoconus and 98 eyes with LI-BK all treated with PKP. Keratoconus eyes showed excellent visual outcomes with DALK and PKP, but graft survival was higher for PKP (100%, 98.9%, and 96.3% vs. 98.6%, 90.6%, and 86.1%, at 1, 3, and 5 years after surgery, respectively; P < 0.0001). There were no significant differences in the ECD up to 1 year after surgery. Greater ECD decline was observed for PKP at 3 and 5 years after surgery. Descemet membrane microperforation was observed in 49 eyes treated with DALK. Postoperative complications in eyes treated with PKP were increased incidence of immunological rejection and secondary glaucoma compared with eyes treated with DALK. LI-BK graft survival rates were excellent in both groups (DSAEK: 89.6% and 86.1%; PKP: 100% and 98.6%, 1- and 2-year rates, respectively; P = 0.17). Best spectacle-corrected visual acuity was better in the DSAEK group, and ECD showed a higher rate of decrease with DSAEK than with PKP. DALK and DSAEK considerably improved surgical outcomes in eyes with keratoconus and those with LI-BK, respectively. However, several key areas require further work, including development of safe surgical methods in DALK and prevention of early postoperative ECD loss in DSAEK.

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“…Bullous keratopathy due to laser iridotomy for primary angle closure/ primary angle-closure glaucoma was added because this type of bullous keratopathy is frequent in Japanese patients. 31,32 Definitions of Graft Failure (1) a cloudy cornea in which there was loss of central graft clarity sufficient to impair vision or (2) a repeat graft for other reasons, including corneal infection, perforation, trauma, or recurrent corneal dystrophy. The date of graft failure was the date of the first examination at which the cornea was cloudy as part of the failure event.…”

Section: Definition Of Original Clinical Diagnosismentioning

confidence: 99%

Long-Term Changes in Corneal Endothelial Cell Density after Repeat Penetrating Keratoplasty in Eyes With Endothelial Decompensation

Hayashi

Kondo²,

Maeno³

et al. 2013

Cornea

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Argon laser iridotomy-induced bullous keratopathy--a growing problem in Japan

Abstract: Bullous keratopathy may arise many years following ALI, and is a growing problem in Asian countries. This condition is a major cause of ocular morbidity in Japan, which has seen a worrying increase in the number of cases in recent years.

Cited by 76 publications

References 17 publications

Analysis of causes of bullous keratopathy in East China: a 10-year retrospective study

Analysis of causes of bullous keratopathy in East China: a 10-year retrospective study

How Much Progress Has Been Made in Corneal Transplantation?

Long-Term Changes in Corneal Endothelial Cell Density after Repeat Penetrating Keratoplasty in Eyes With Endothelial Decompensation

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