Keratoplasty in Treatment of Keratoconus

Castroviejo, Ramón

doi:10.1001/archopht.1949.00900050787007

Cited by 25 publications

(19 citation statements)

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“…Grafts with total or partial oedema were counted as failed or failing. Graft rejection was diagnosed by the appearance in a previously clear graft of at least one of the following: (1) endothelial rejection line; (2) keratic precipitates; or (3) localised graft oedema, the edge of which usually coincided with the keratic precipitates.…”

Section: Methodsmentioning

confidence: 99%

Penetrating keratoplasty for keratoconus: complications and long-term success.

Sharif

Casey

1991

British Journal of Ophthalmology

146

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A series of 100 penetrating keratoplasties for keratoconus performed between 1968 and 1986 were reviewed for long-term results. The mean follow-up was 6-1 years with a range of f-16 years. The systemic associations and the postoperative complications were analysed. Grafting in cases associated with Down's syndrome had a higher incidence of complications. 93% of grafts remained clear and 81% achieved a final corrected visual acuity of 6/12 or better. 21% of eyes developed a homograft reaction, with 50% of rejection episodes occurring in the first year after operation. Factors associated with higher incidence of rejection included loose sutures, traumatic wound dehiscence, and grafts larger than 8-5 mm. Only three grafts with rejection episodes lost graft clarity, while rejection in the rest was successfully reversed with topical steroid therapy. No relationship was found between donor age and long-term graft clarity.

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Section: Methodsmentioning

confidence: 99%

Penetrating keratoplasty for keratoconus: complications and long-term success.

Sharif

Casey

1991

British Journal of Ophthalmology

146

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“…Corneal transplantation can be performed as either deep lamellar anterior keratoplasty (DALK) or conventional PK (Castroviejo, 1949; Melles et al, 1999; Anwar & Teichmann, 2002). Sparing of the patients endothelial cells is an important advantage of DALK technique; however, major side effects of keratoplasty are a risk for high degree of astigmatism and a long recovery time.…”

Section: Keratoconusmentioning

confidence: 99%

Pathogenesis of Keratoconus: The intriguing therapeutic potential of Prolactin-inducible protein

Sharif

Bak‐Nielsen

Hjortdal

et al. 2018

Progress in Retinal and Eye Research

103

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Keratoconus (KC) is the most common ectatic corneal disease, with clinical findings that include discomfort, visual disturbance and possible blindness if left untreated. KC affects approximately 1:400 to 1:2000 people worldwide, including both males and females. The aetiology and onset of KC remains a puzzle and as a result, the ability to treat or reverse the disease is hampered. Sex hormones are known to play a role in the maintenance of the structure and integrity of the human cornea. Hormone levels have been reported to alter corneal thickness, curvature, and sensitivity during different times of menstrual cycle. Surprisingly, the role of sex hormones in corneal diseases and KC has been largely neglected. Prolactin-induced protein, known to be regulated by sex hormones, is a new KC biomarker that has been recently proposed. Studies herein discuss the role of sex hormones as a control mechanism for KC onset and progression and evidence supporting the view that prolactin-induced protein is an important hormonally regulated biomarker in KC is discussed.

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“…1 Intense inflammation can occur shortly after surgery resulting in wound dehiscence, failure of epithelialisation, and early rejection called post-keratoplasty atopic sclerokeratitis (PKAS). 2 This condition occurs uncommonly particularly in atopic individuals with high (>1000 IU/ml) serum IgE.…”

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confidence: 99%

Use of cyclosporin in the treatment of steroid resistant post-keratoplasty atopic sclerokeratitis

Daniell

Dart²,

Lightman³

2001

British Journal of Ophthalmology

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Aims-To demonstrate that oral cyclosporin is successful in the management of steroid refractory post-keratoplasty atopic sclerokeratitis (PKAS). Methods-Series of three patients.Results-The patients developed PKAS between 2 and 11 days after surgery. All cases failed to respond to oral prednisolone 60-80 mg daily for 10-30 days but resolved with the addition of systemic cyclosporin 5.0-7.5 mg/kg/day. There have been no relapses following withdrawal of therapy after 3-18 months. Conclusions-PKAS is an uncommon, but severe, complication of corneal graft surgery and often responds to oral prednisolone treatment. Oral cyclosporin results in rapid resolution of PKAS in steroid unresponsive cases. (Br J Ophthalmol 2001;85:91-92) Penetrating keratoplasty may be required to treat keratoconus and corneal scarring associated with atopy related eye diseases.1 Intense inflammation can occur shortly after surgery resulting in wound dehiscence, failure of epithelialisation, and early rejection called post-keratoplasty atopic sclerokeratitis (PKAS).2 This condition occurs uncommonly particularly in atopic individuals with high (>1000 IU/ml) serum IgE. They present up to 10 days postoperatively with severe photophobia, pain, epiphora, mucus discharge, intense conjunctival and anterior scleral injection with mucus adherent to the sutures which can cheesewire through the inflamed tissues leading to wound slippage and frank dehiscence. Later, microbial keratitis and graft rejection supervene. However, if treated early with high dose oral prednisolone, in many patients the inflammation can be controlled quickly and the prognosis is good with no recurrences. 2 We describe three cases in which oral steroids did not control the inflammation and cyclosporin was added with rapid improvement. Although therapy over many months was required, both drugs were eventually stopped. Case reports CASE 1This 25 year old man with previous vernal keratoconjunctivitis had keratoconus diagnosed at the age of 9. At surgery the best corrected left acuity was 6/12 and 6/120 right with a cone too steep for contact lens fitting. His serum IgE was 120 IU/l preoperatively. A right (8 mm) penetrating keratoplasty was performed using 16 interrupted sutures and subconjunctival betnesol at the end of surgery.The day after surgery there was minimal inflammation but at 4 days postoperatively, he developed acute inflammation, photophobia, and pain in the right eye and was diagnosed as having PKAS. Dexamethasone eye drops 0.1% were increased to hourly and prednisolone 80 mg daily was added. After 8 days (day 15 postoperatively), there was less pain but severe inflammation remained with anterior scleritis and infiltrates at the host insertion of some sutures. Oral cyclosporin (Sandimmun, Novartis), was added at 5 mg/kg/day. The inflammation completely resolved over the subsequent 12 days (by 27 days postoperatively) and the prednisolone was reduced over the following 3 months when it was stopped, followed by the cyclosporin. Two loose corneal sutures were...

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Keratoplasty in Treatment of Keratoconus

Cited by 25 publications

References 1 publication

Penetrating keratoplasty for keratoconus: complications and long-term success.

Penetrating keratoplasty for keratoconus: complications and long-term success.

Pathogenesis of Keratoconus: The intriguing therapeutic potential of Prolactin-inducible protein

Use of cyclosporin in the treatment of steroid resistant post-keratoplasty atopic sclerokeratitis

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