Long term visual outcomes, graft survival and complications of deep anterior lamellar keratoplasty in patients with herpes simplex related corneal scarring

Lyall, Douglas; Tarafdar, Sonali; Gilhooly, Michael James; Roberts, Fiona; Ramaesh, Kanna

doi:10.1136/bjophthalmol-2012-301947

Cited by 31 publications

(21 citation statements)

References 16 publications

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“…Recent advances in corneal transplantation techniques with a shift from penetrating to safer lamellar procedures and wide application of limbal epithelial stem cell transplantation, have resulted in improved outcomes, and have expanded the number of cases of corneal blindness that can now be treated successfully . However, patients with severe pathologies (e.g., chemical burns, previously rejected grafts, autoimmune disease, and infections) still have a high risk of rejection and failure, often needing multiple surgeries . Corneal prostheses are available, but they remain mainly for end‐stage disease and even if implanted as primary procedure they often are accompanied by vision‐threatening complications, leaving an unmet need for a de novo solution for high‐risk patients.…”

Section: Introductionmentioning

confidence: 99%

“…2 However, patients with severe pathologies (e.g., chemical burns, previously rejected graft s, autoimmune disease, and infections) still have a high risk of rejection and failure, oft en needing multiple surgeries. [3][4][5][6][7][8] Corneal prostheses are available, but they remain mainly for end-stage disease and even if implanted as primary procedure they oft en are accompanied by visionthreatening complications, 1,9 leaving an unmet need for a de novo solution for high-risk patients.…”

Section: Introductionmentioning

confidence: 99%

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Bioengineered Corneas Grafted as Alternatives to Human Donor Corneas in Three High‐Risk Patients

Buznyk

Pasyechnikova

Islam

et al. 2015

Clinical Translational Sci

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Corneas with severe pathologies have a high risk of rejection when conventionally grafted with human donor tissues. In this early observational study, we grafted bioengineered corneal implants made from recombinant human collagen and synthetic phosphorylcholine polymer into three patients for whom donor cornea transplantation carried a high risk of transplant failure. These patients suffered from corneal ulcers and recurrent erosions preoperatively. The implants provided relief from pain and discomfort, restored corneal integrity by promoting endogenous regeneration of corneal tissues, and improved vision in two of three patients. Such implants could in the future be alternatives to donor corneas for high-risk patients, and therefore, merits further testing in a clinical trial.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bioengineered Corneas Grafted as Alternatives to Human Donor Corneas in Three High‐Risk Patients

Buznyk

Pasyechnikova

Islam

et al. 2015

Clinical Translational Sci

View full text Add to dashboard Cite

show abstract

“…[14][15][16] In addition to the obvious advantage of absence of endothelial graft rejection, DALK allows the use of poor-quality donor corneas thereby alleviating the problem of shortage of donor corneas in the developing world. 20,21 Considering these factors, we performed DALK for patients with deep HSKinduced corneal scars with functional endothelium.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported encouraging outcomes of DALK in treating HSK-related corneal scarring in which posterior lamella and endothelium were not compromised. [14][15][16] These reports indicated that the depth of the scar should not exceed two thirds of the stroma. In this study, we report the long-term outcomes of DALK in deep stromal HSK-related corneal scars with or without associated posterior stromal folds approaching the endothelium.…”

mentioning

confidence: 93%

Long-Term Outcomes of Deep Anterior Lamellar Keratoplasty Treating Posterior Stroma–Implicated Herpetic Corneal Opacities

Ren

Wang

Zheng³

et al. 2016

Cornea

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“…DALK shows comparable visual outcome and better graft survival rate than PK , though there is a high percentage of complications post‐DALK …”

Section: Prevention Of and Treatment For Corneal Diseasementioning

confidence: 99%

Corneal blindness and xenotransplantation

Lamm

Hara

Mammen

et al. 2014

Xenotransplantation

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Approximately 39 million people are blind worldwide, with an estimated 285 million visually impaired. The developing world shoulders 90% of the world’s blindness, with 80% of causative diseases being preventable or treatable. Blindness has a major detrimental impact on the patient, community, and healthcare spending. Corneal diseases are significant causes of blindness, affecting at least 4 million people worldwide. The prevalence of corneal disease varies among parts of the world. Trachoma, for instance, is the second leading cause of blindness in Africa, after cataracts, but is rarely found today in developed nations. When preventive strategies have failed, corneal transplantation is the most effective treatment for advanced corneal disease. The major surgical techniques for corneal transplantation include penetrating keratoplasty (PK), anterior lamellar keratoplasty (ALK), and endothelial keratoplasty (EK). Indications for corneal transplantation vary among countries, with Fuchs’ dystrophy being the leading indication in the U.S. and keratoconus in Australia. With the exception of the US, where EK will soon overtake PK as the most common surgical procedure, PK is the overwhelming procedure of choice. Success using corneal grafts in developing nations, such as Nepal, demonstrates the feasibility of corneal transplantation on a global scale. The number of suitable corneas from deceased human donors that becomes available will never be sufficient, and so research into various alternatives, e.g., stem cells, amniotic membrane transplantation, synthetic and biosynthetic corneas, and xenotransplantation, is progressing. While each of these has potential, we suggest that xenotransplantation holds the greatest potential for a corneal replacement. With the increasing availability of genetically-engineered pigs, pig corneas may alleviate the global shortage of corneas in the near future.

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Long term visual outcomes, graft survival and complications of deep anterior lamellar keratoplasty in patients with herpes simplex related corneal scarring

Cited by 31 publications

References 16 publications

Bioengineered Corneas Grafted as Alternatives to Human Donor Corneas in Three High‐Risk Patients

Bioengineered Corneas Grafted as Alternatives to Human Donor Corneas in Three High‐Risk Patients

Long-Term Outcomes of Deep Anterior Lamellar Keratoplasty Treating Posterior Stroma–Implicated Herpetic Corneal Opacities

Corneal blindness and xenotransplantation

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