Current indications and surgical approaches to corneal transplants at the University of Toronto: A clinical-pathological study

Le, Ryan; Yucel, Narain; Khattak, Shireen; Yücel, Yeni H.; Prud’homme, Gérald J.; Gupta, Neeru

doi:10.1016/j.jcjo.2016.07.005

Cited by 34 publications

(39 citation statements)

References 38 publications

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“…FECD was managed by DSAEK in 83 per cent cases and PKP in 13 per cent in 2011-2012. Le et al 30 evaluated the current surgical approaches at the University of Toronto and found that 61 per cent of keratoplasties were LK and 39 per cent underwent full-thickness PKP. Amongst the lamellar procedures, DSAEK accounted for most of the surgeries (68%) followed equally by DALK (16%) and DMEK (16%).…”

Section: Review Of Literature: Changing Trendsmentioning

confidence: 99%

“…According to Le et al 30, the most common indication for PKP was graft failure (30%) followed by infection (18%), and keratoconus (17%). DSAEK was most commonly done for FECD (40%) and bullous keratopathy (33%).…”

Section: Review Of Literature: Changing Trendsmentioning

confidence: 99%

“…Keratoconus (57%) and corneal scarring (35%) were found to be the most common indications for DALK. DMEK was done mostly in cases of FECD (82%)30.…”

Section: Review Of Literature: Changing Trendsmentioning

confidence: 99%

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Corneal transplantation in the modern era

Singh

Gupta

Vanathi

et al. 2019

Indian Journal of Medical Research

129

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Corneal blindness is one of the major causes of reversible blindness, which can be managed with transplantation of a healthy donor cornea. It is the most successful organ transplantation in the human body as cornea is devoid of vasculature, minimizing the risk of graft rejection. The first successful transplant was performed by Zirm, and since then, corneal transplantation has seen significant evolution. It has been possible because of the relentless efforts by researchers and the increase in knowledge about corneal anatomy, improvement in instruments and advancements in technology. Keratoplasty has come a long way since the initial surgeries wherein the whole cornea was replaced to the present day where only the selective diseased layer can be replaced. These newer procedures maintain structural integrity and avoid catastrophic complications associated with open globe surgery. Corneal transplantation procedures are broadly classified as full-thickness penetrating keratoplasty and partial lamellar corneal surgeries which include anterior lamellar keratoplasty [sperficial anterior lamellar keratoplasty (SALK), automated lamellar therapeutic keratoplasty (ALTK) and deep anterior lamellar keratoplasty (DALK)] and posterior lamellar keratoplasty [Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK)] broadly.

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Section: Review Of Literature: Changing Trendsmentioning

confidence: 99%

Section: Review Of Literature: Changing Trendsmentioning

confidence: 99%

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Corneal transplantation in the modern era

Singh

Gupta

Vanathi

et al. 2019

Indian Journal of Medical Research

129

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“…In general, older patients are less likely to have frequent rejection episodes, as their immune systems are not as strong as young patients. 39 , 40 , 41 The most common indication for DALK is keratoconus, 42 and these patients tend to be younger. Hence, in comparison to PK, DALK offers an advantage of reduced chances of rejection.…”

Section: Resultsmentioning

confidence: 99%

Deep anterior lamellar keratoplasty: A surgeon's guide

Nanavaty

Vijjan

Yvon

2018

Journal of Current Ophthalmology

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PurposeTo review and highlight important practical aspects of deep anterior lamellar keratoplasty (DALK) surgery and provide some useful tips for surgeons wishing to convert to this procedure from the conventional penetrating keratoplasty (PK) technique.MethodsIn this narrative review, the procedure of DALK is described in detail. Important pre, intra, and postoperative considerations are discussed with illustrative examples for better understanding. A comprehensive literature review was conducted in PubMed/Medline from January 1995 to July 2017 to identify original studies in English language regarding DALK. The primary endpoint of this review was the narrative description of surgical steps for DALK, its pitfalls, and management of common intraoperative complications.ResultsA standard DALK procedure can be successfully performed taking into consideration factors such as age, ophthalmic co-morbidities, status of the crystalline lens, retina, and intraocular pressure. Careful trephination and dissection of the host cornea employing appropriate technique (such as big bubble technique, manual dissection, visco-dissection, etc.) suitable for the specific case is important to achieve good postoperative outcomes. Prompt identification of intraoperative complications such as double bubble, micro and macroperforations, etc. are vital to change the management strategies.ConclusionAlthough there is a steep learning curve for DALK procedure, considering details and having insight into the management of intraoperative issues facilitates learning and reduces complication rates.

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“…[2] Leading indications for keratoplasty and implemented surgical techniques vary from one country to another depending on their geographic regions, socioeconomic conditions, and adaptation to recent surgical technological advancements. [3][4][5][6][7][8][9][10][11] For instance, in developed countries, bullous keratopathy (BK) and Fuchs' endothelial dystrophy (FED) are the leading indications for keratoplasty, and with the adaptation of endothelial keratoplasty (EK) techniques in these countries, Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) are the procedures of choice to selectively replace the diseased corneal endothelium. [4][5][6][7][8]11] However, the leading indications for keratoplasty in developing countries vary from keratoconus (KCN) in Iran and Zimbabwe [3,12,13] to infectious keratitis and corneal scarring in China and India.…”

Section: Corneal Blindness Is the Third Leading Cause Of Avoidable VImentioning

confidence: 99%

A 27-Year Report from the Central Eye Bank of Iran: A complete translation from Farsi

Javadi

Kanavi

Safi

2020

JOVR

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Purpose: To report the 27-year statistical data from the Central Eye Bank of Iran (CEBI) and its activity. Methods: All CEBI records regarding procured eyes, tissue utilizations, corneal transplants per capita, and indications for keratoplasty from 1991 to 2017 were analyzed. Results: In total, 115,743 whole eyes were donated during the 27-year period. Out of the 114,169 eyes donated between 1994 and 2017, 95,314 eyes were distributed for transplantation, and 95,057 corneas were actually transplanted. The mean annual rate of corneal transplants per capita was 55.10−6 ± 27.10−6. Although penetrating keratoplasty (PKP, 70%) was the most common technique of corneal transplantation during the study period, it exhibited a decreasing trend between 2006 and 2017 (P = 0.048). It was in contrast to Descemet stripping automated endothelial keratoplasty (DSAEK) that demonstrated an increasing trend during the same period (P < 0.001). Keratoconus (KCN, 39.70%) was the most leading indication for keratoplasty over the last three decades followed by bullous keratopathy (BK, 18.5%), corneal scar and opacities (15.7%), and graft failure (GF, 7.5%), with an increasing trend for BK, GF, and KCN. A majority of scleral tissues (83.7%) were utilized for orbital implant protection. Conclusion: An increasing trend in the number of procured eyes was observed over the past 27 years in Iran. The most leading indications for corneal transplantation were KCN and BK. While PKP was the most common keratoplasty technique, DSAEK showed an increasing trend over the last 12 years.

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Current indications and surgical approaches to corneal transplants at the University of Toronto: A clinical-pathological study

Cited by 34 publications

References 38 publications

Corneal transplantation in the modern era

Corneal transplantation in the modern era

Deep anterior lamellar keratoplasty: A surgeon's guide

A 27-Year Report from the Central Eye Bank of Iran: A complete translation from Farsi

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