Long-term results of penetrating keratoplasty

Muraine, M.; Sanchez, Christina; Watt, Laure; Retout, A.; Brasseur, G.

doi:10.1007/s00417-003-0691-z

Cited by 76 publications

(48 citation statements)

References 28 publications

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“…In our series of corneal graft patients, the incidence was 9.6% lower than that reported in the literature, [1][2][3][4][5][6] where incidences of 10-36% have been described. In addition, our value is probably an overestimate because pre-operative OCT was not performed (due to corneal transparency), and some patients may have had pre-operative MO.…”

Section: Discussioncontrasting

confidence: 59%

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Optical Coherence Tomography Evaluation of Macular Oedema after Corneal Graft

Genevois¹,

Gardea²,

Muraine³

2007

European Ophthalmic Review

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Macular oedema (MO) is an established complication of intraocular surgery and is one of the leading causes of poor post-operative visual acuity after keratoplasty. [1][2][3][4][5][6][7] MO is a localised expansion of the retinal intracellular and/or extracellular space in the macular area. This tendency towards the macular region is probably associated with the loose binding of innerconnecting fibres in Henle's layer, allowing accumulation of fluid leaking from peri-foveal capillaries.The aim of this study 8 was to assess the incidence of MO following keratoplasty and to identify factors that are associated with oedema using optical coherence tomography (OCT). The device utilised was an OCT 3 (Stratus, Carl Zeiss Meditec, Dublin, California), the only device capable of providing a detailed analysis of retinal tissue, and an objective, reproducible and reliable measurement of retinal thickness. 7,9 OCT is a highly sensitive tool that allows reproducible measurements of retinal thickness with reproducibility of ±5%. It is a more powerful investigative tool than the biomicroscopic or angiographic examinations previously reported in the literature: both are qualitative and insensitive to small changes in retinal thickness. Materials and MethodsThis prospective study involved 62 patients who were all operated on by the same surgeon. Informed consent was obtained from all patients.Forty-three (69.35%) underwent penetrating keratoplasty and 19 (30.65%) deep anterior lamellar keratoplasty (using the big-bubble technique). We realised a deep anterior keratoplasty with pathologies involving the corneal stroma and sparing the Descemet membrane.Combined surgery was performed for 20 patients. Of this number there were secondary implantations for nine patients, cataract extractions for eight and iris plasties for three. The indications for surgery were as follows: keratoconus in 18 cases, pseudophakic or aphakic keratopathy in 18 cases, Fuchs dystrophy in 10 cases, viral corneal scar in seven cases, re-graft in five cases and corneal oedema following closed angle glaucoma in four cases.We analysed the morphological characteristics of the macula by OCT 3 one and three months after surgery using 'line group' mode, with 6mm sections centred on the patient's fixation point along various axes. We also measured central macular thickness (CMT). CMT was defined as the average thickness of a central macular region 1000µm in diameter, centred on the patient's foveola and automatically measured by OCT 3 and A5 mapping software (Humphrey Instruments, Dublin, California).MO was defined as increased central retinal thickness, to more than 250µ (retinal thickness in healthy eyes is 212±20µ) 8 with intra-retinal cystoid-like spaces that appeared as round or oval areas of low reflectivity. OCT investigations before keratoplasty were not possible due to corneal transparency. Student's t-test and Fisher's test were used for statistical analysis. ResultsOCT carried out one and three months after surgery revealed normal macular profiles in 54 of ...

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Section: Discussioncontrasting

confidence: 59%

“…[1][2][3][4][5][6][7] MO is a localised expansion of the retinal intracellular and/or extracellular space in the macular area. This tendency towards the macular region is probably associated with the loose binding of innerconnecting fibres in Henle's layer, allowing accumulation of fluid leaking from peri-foveal capillaries.…”

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confidence: 99%

Optical Coherence Tomography Evaluation of Macular Oedema after Corneal Graft

Genevois¹,

Gardea²,

Muraine³

2007

European Ophthalmic Review

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“…Graft clarity rate can reach the extent of 97 % after 4 years in the low-risk group [13]. In transplanted corneas, endothelium can keep its function in some cases even for 30 years [14][15][16][17], with an initial cell density above 2,500 cells/mm 2 ( Table 2). Minimal cell density at the time of PKP is reported to range between 2,000 and 2,500 cells/mm 2 and the minimal, critical cell density limit for corneal decompensation is 250-500 cells/mm 2 [14,15,[18][19][20][21].…”

Section: Resultsmentioning

confidence: 99%

Assessment of endothelial cell density and corneal thickness in corneal grafts an average of 5 years after penetrating keratoplasty

Kettesy

Németh

Kemény-Beke

et al. 2014

Wien Klin Wochenschr

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SummaryBackground Corneal transparency is a useful indicator for corneal function. Our aim was to investigate central corneal endothelial cells and corneal thickness in transplanted corneas at an average of 5.4 years after penetrating keratoplastyPatients and methods The study involved 68 perforated keratoplasty patients with at least a 1 year followup. Post-operatively, the central corneal endothelial layer was observed using a contact specular microscope. Central endothelial cell density, corneal thickness and the coefficient of variation of endothelial size were statistically analysed.Results The post-operative follow-up time was ranging from 12 months to 23 years. Endothelial cell density (ECD) was 1,501 ± 249 cell/mm 2 . The average cell size was 673.6 ± 98.3 μm 2 , and the coefficient of variation of cell size was 0.61 ± 0.11. No difference in ECD was detected between diagnostic groups. Corneal thickness was 0.56 ± 0.06 mm. Correlation between ECD and post-operative time was not significant (r = 0.02; p = 0.85).Conclusion Our study concluded that ECD showed a higher rate of decrease after penetrating keratoplasty with no relation to pre-operative diagnosis.Keywords Endothelial cell loss · graft survival · penetrating keratoplasty · specular microscope Bestimmung der Endothelzelldichte und der Hornhautdicke in Hornhauttransplantaten circa 5 Jahre nach einer penetrierenden Keratoplastik Zusammenfassung Hintergrund Die Transparenz der Cornea ist ein nütz-licher Indikator der Funktion der Hornhaut. Das Ziel unserer Studie war es, die zentralen Endothelzellen der Cornea sowie die Dicke der Hornhaut in transplantierten Hornhäuten circa 5,4 (im Durchschnitt) Jahre nach penetrierender Keratoplastik zu untersuchen.Patienten und Methoden In die Studie wurden 68 Patienten nach perforierter Keratoplastik aufgenommen, die zumindest 1 Jahr nachuntersucht worden waren. Postoperativ wurde die zentrale Endothelschicht der Hornhautmittel seines Kontakt-Spekular Mikroskops untersucht. Die Dichte der zentralen Endothelzellen, die Dicke der Hornhaut und der Variations-Koeffizient der Größe des Endothels wurden statistisch analysiert.Ergebnisse Der Zeitpunkt der postoperativen Kontrollen variierte von 12 Monaten bis 23 Jahren. Die Endothelzelldichte (EZD) lag bei 1501 ± 249 Zelle/mm 2 . Der Mittelwert der Zellgröße war 673,6 ± 98,3 μm 2 und der Variationskoeffizient 0,61 ± 0,11. Es gab keinen Unterschied in der EZD zwischen den nach Diagnosen eingeteilten Gruppen. Die Korrelation zwischen der EZD und dem Zeitabstand zur Operation war nicht kant (r = 0,02; p = 0,85).Schlussfolgerung Unsere Studie zeigt unabhängig von der präoperativen Diagnose eine abfallende Tendenz der EZD nach penetrierender Keratoplastik.

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“…However, in patients undergoing repeat keratoplasty, results have been disappointing with long-term graft survival rates of only 28-55% over 5 years and 11% at 10 years. [1][2][3][4] In addition, PK has shown poor visual outcomes and unacceptable failure and complication rates in high-risk conditions, such as aniridia, herpetic keratitis, severe chemical burns, and cicatrizing diseases such as ocular cicatricial pemphigoid (OCP) and StevensJohnson syndrome. [5][6][7][8] Thus, the need for a new strategy for patients with poor PK prognosis has resulted in the emergence of the artificial cornea or keratoprosthesis.…”

Section: Introductionmentioning

confidence: 99%