Penetrating keratoplasty with or without intraocular lens implantation is necessary to restore a vision of an eye with aphakic bullous keratopathy. We analyzed surgical outcomes in eleven aphakic bullous keratopathy patients(11, eyes) who received penetrat-ing keratoplasty with scleral-fixated posterior chamber lens(PCL)at Kangnam St.Mary's hospital from January, 1989 to December 1991 and followed up more than 1 year Eight of eleven eyes showed the postoperative corrected VlSlOn of 0.3 to 0.8 at postoperative one year. The cuases of poor vision below 0.3 were age-related macular degeneration(1 eye), graft failure(I eye) and diabetic retinopathy(1 eye). At one year after surgery, mean spherical equivalent was-1.12, mean astigmatism was 4.21D and percent loss of corneal endothelium was 35.5%. Graft rejection(3 eyes) and secondary glaucoma(1 eye) were occured during the postoplasty with scleral-fixated PCL can be an excellent surgical technique to get visual rehabilitaion of patients with an aphakic bullous keratopathy.
Astigmatism ; Corneal Transplantation ; Endothelium, Corneal ; Humans ; Keratoplasty, Penetrating* ; Lens Implantation, Intraocular ; Transplants

The functional restoration of the corneal endothelium is vital to the success of penetrating keratoplasty and essential in maintaining corneal clarity. The corneal thickness is the important prognostic factors for penetrating keratoplasty and evaluated with pachymetry. We studied the serial corneal thickness change after penetrating keratoplasty to evaluate the integrity of the corneal endotehlium and to determine the prognostic value. We found the Pearsons coorelation coefficient and evaluate the effect of following parameters with such as donor age, donror cornea status, enucleation time, corneal storage time, preoperative diagnosis, operation methods, lens status and post operative course on the changes of corneal thickness. The central corneal thickness was measured in 41 eye and averaged 0.716 mm. in the post operative 1 day. Average central corneal thickness progressively decreased following penetrating keratoplasty and reached the stabilization of corneal thikckness at the postoperative 30 days with 0.537mm. Factors influencing on the corneal thickness are lens status, combined procedure with keratoplasty, longer enucleation time, complications during the follow-up course.
Cornea ; Corneal Transplantation ; Diagnosis ; Endothelium, Corneal ; Follow-Up Studies ; Humans ; Keratoplasty, Penetrating* ; Tissue Donors

The purpose of this study is to determine the effects of radial keratotomy (RK) and deep lamellar keratoplasty(DLKP) on the corneal endothelium and to disclose the difference in endothelial cellular changes induced by these two operative procedures. The subjects consisting of 24 adult rabbits were equally divided into two groups ,of RK and DLKP. The operations were performed only on the left eyes and the unoperated right eyes were used as controls in scanning electron microscopic study. In RK, the knife blade was set at the depth of 90% of the corneal thickness and, in DLKP, the same depth was also reached. The endothelial cell density was measured under specular microscope and the morphology was observed through scanning electron microscope. The cellular changes were evaluated immediately, 1 day, 10 days and 30 days after operation. The results were as follows: 1. The loss of endothelial cells 1 day after operation was 5.5% in RK group and 7.4% in DLKP group, showing more marked damage in DLKP group than in RK group. However, the losses in 10 and 30 days showed no significant difference between these two groups. 2. In the scanning electron microscopic study, DLKP group showed more pronounced cellular swelling than RK group in 1 day. However, the difference was only minimal 10 and 30 days after operation. 3. In view of the above findings, DLKP seems to cause more damage on corneal endothelial cells than RK, althongh rabbit endothelial cells, unlike human cells, are known to regenerate.
Adult ; Corneal Transplantation* ; Endothelial Cells ; Endothelium, Corneal ; Humans ; Keratotomy, Radial* ; Rabbits ; Surgical Procedures, Operative

We performed the deep lamellar keratoplasties in which stroma about 90% in thickness were removed on 15 patients(12 males and 3 females). The patients included in this study showed deep corneal opacity preserving endothelium intact. During the operation, we experienced microperforation in 3 cases, but no complications were found with immediate closure. After the operation, all patients acquired the corneal clarity except one whose cornea was opaque as the Grade II by the slit lamp examination. The patients had visual improvement of two lines or more in Snellen chart. Three patients had no change of visual acuity and one patient bad astigmatism more than 3D. Only one patient suffered the stromal rejection raction, but improved with the use of oral steroid and topical steroid eye drops.
Astigmatism ; Cornea ; Corneal Opacity ; Corneal Transplantation* ; Endothelium ; Humans ; Male ; Ophthalmic Solutions ; Visual Acuity

PURPOSE: To evaluate the factors that affect visual outcome and transplanted corneal endothelial cell density in eyes that have undergone cataract surgery after penetrating keratoplasty, and to compare surgical outcomes with those of a control group. METHODS: We conducted a retrospective review of case records of 20 eyes that had undergone cataract surgery between January 2003 and April 2006 after previous penetrating keratoplasty (group I) and 20 eyes that had undergone cataract surgery alone with low cornea endothelial cell density (group II). RESULTS: For both groups, the grade of nucleosclerosis affected postoperative best corrected visual acuity (BCVA) and the total phaco energy (phaco power X time) did not affect either BCVA or endothelial cell density. In group I, the factor that most affected change in corneal endothelial cell density after cataract surgery was the time interval between keratoplasty and phacoemulsification. Comparison of the surgical results showed an increase in BCVA for both groups, and the difference between the two groups was not statistically significant. However, group I showed a significantly greater decrease in corneal endothelial cell density than did group II. CONCLUSIONS: Our results suggest that the corneal endothelial cells of the eye having previously undergone penertrating keratoplasty are vulnerable to surgical insult occurring in procedures such as cataract surgery, and that the time interval between the two procedures can affect the change in endothelial cell density.
Cataract ; Cornea ; Corneal Transplantation ; Endothelial Cells ; Endothelium, Corneal ; Keratoplasty, Penetrating* ; Phacoemulsification* ; Retrospective Studies ; Visual Acuity

OBJECTIVETo evaluate the feasibility of using cultured corneal endothelial cell (CECs) transplantation for cornea endothelium cell destruction with Gelatin membrane as the carrier in rabbits.

METHODSThe cultured CECs were labeled by Brdu and subcultured in vitro on glutaraldehyde-fixed Gelatin membranes and then the membranes were glued by alpha-cyanoacrylate alkyl to 7.00 mm autologous rabbit corneal bottons whose endothelium were mechanically removed previously. The buttons were sutured in place. With this method the right eyes of 21 rabbits were transplanted with CECs, and the right eyes of another 17 rabbits were transplanted with non-cells carrier as controls. The rabbits were bred and observed by slit microscopy and confocal microscopy at 1, 2, 4, 8, and 12 weeks after surgeries. Also, introcular pressure and corneal thickness were measured by Perkin's tonometer and ultrasonic pachymeter. After 12 weeks, all the animals were sacrificed and the grafts were examined by light microscopy and electronic microscopy.

RESULTSCECs grew well on the gelatine memberane, and formed confluent monolayers in 3-5 days; the cell density reached as high as 2700 cells/mm2. After 2 weeks of operation, all corneal buttons were edema and began to be opaque. The control eyes remained opaque throughout the observation period. In eyes with CECs transplanted, the grafts began to be clear and thin 4 weeks after operation. The cell density of grafts decreased along with time, and the mean cell density of CECs transplantation buttons was (2023.3 +/- 330.3) cells/mm2 12 weeks after operation. The transplanted cells were stained with the anti-Brdu monoclonal antibody.

CONCLUSIONIt is feasible to culture and translate CECs with the Gelatin membrane.

Animals ; Cells, Cultured ; Corneal Endothelial Cell Loss ; pathology ; therapy ; Endothelial Cells ; transplantation ; Endothelium, Corneal ; cytology ; Rabbits

PURPOSE: Posterior lamella keratoplasty has been described as a new procedure to treat corneal conditions involving endothelial dysfunction by selective transplantation of only the posterior corneal tissue composed of the endothelium, Descemet membrane, and posterior stroma. This study has been conducted to evaluate the recovery of endothelial function and adhesion mechanism of transplanted posterior corneal tissue to the donor stroma after posterior lamella keratoplasty. METHODS: Dog corneal endothelium and posterior stroma were transplanted to recipient dog cornea stripped of endothelium and posterior stroma. The recovery of endothelial function and corneal thickness were measured by specular microscopy; pachymetry and slit lamp examination were done immediately after posterior lamella keratoplasty and at 1, 2, 4, 8 weeks post-operative. Eight weeks after operation, enucleation was performed and the histopathologic changes in the transplanted area of enucleated eyes were examined by light microscopy, fluorescent microscopy, and electron microscopy. RESULTS: Corneal thickness, endothelial function, and corneal transparency were recovered by the end of experiment. The newly produced collagen fibrils were absent at the corneal posterior flap and anterior stromal bed interface. The collagen fibrils adjacent to the flap interface were irregularly arranged and morphologically transformed in some cases (2 of 8 cases) and were linearly arranged in a parallel manner in others (6 of 8 cases). CONCLUSIONS: It can be suggested that the stability of transplanted posterior corneal flap is maintained by incomplete wound healing and recovery of corneal endothelial function.
Animals ; Collagen ; Cornea ; Corneal Transplantation* ; Descemet Membrane ; Dogs ; Endothelium ; Endothelium, Corneal ; Humans ; Microscopy ; Microscopy, Electron ; Tissue Donors ; Transplants* ; Wound Healing

The method of gene transfer into corneal endothelium was investigated to provide a foundation for the study of TGF-beta 1 gene transfer to inhibit corneal graft rejection. Two days after direct injection of pMAM TGF-beta 1 mediated by liposome into the anterior chamber of rabbits, one half of corneas were made into paraffin slides and the endothelial layer was carefully torn from the other half to make a single layer slide of endothelia. By means of immunohistochemical technique, the plasmid pMAM TGF-beta 1 expression product TGF-beta 1 in the endothelia was detected. Specific TGF-beta 1 expression was positive in the endothelia on both the paraffin slide and the single layer slide. The results showed that by direct injection into the anterior chamber, foreign plasmid DNA could be transferred into the endothelia and its expression was obtained. This may provide a foundation for further study on TGF-beta 1 participating in local induction of corneal immune tolerance.
Anterior Chamber ; Corneal Transplantation ; Endothelium, Corneal/*drug effects ; Endothelium, Corneal/pathology ; Gene Transfer Techniques ; Immune Tolerance ; Transforming Growth Factor beta/administration &

PURPOSE: To compare the therapeutic outcomes after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) in patients with keratoconus. METHODS: We retrospectively reviewed the clinical records of 57 patients diagnosed with keratoconus who had undergone DALK (19 eyes of 19 patients) and PKP (38 eyes of 38 patients) in Samsung medical center between January 1995 and January 2006. RESULTS: The 19 and 38 patients with keratoconus who underwent DALK and PKP had mean ages of 25.3 (range: 17-46) and 26.2 (range: 12-51) years, respectively. These groups were followed up for mean times of 16.7 (range: 6-34) and 45.7 (range: 6-115) months after surgery, respectively. The DALK group showed significantly higher values of refractive power, central corneal thickness, and endothelial cell density, while two eyes (10.5%) in the DALK group developed stromal rejection, which resolved after steroid therapy. In the PKP group, eight eyes (21%) developed endothelial rejection, among whom one eye (2.6%) resulted in a graft failure of a patient who underwent re-PKP, and two eyes (5.3%) in the PKP group developed secondary glaucoma. CONCLUSIONS: DALK should be considered as the primary surgical technique in keratoconus, because the visual outcome is comparable with PKP and it reduces severe complications such as secondary glaucoma and the risk of graft failure by preserving the corneal endothelium compared to PKP.
Corneal Transplantation ; Endothelial Cells ; Endothelium, Corneal ; Eye ; Glaucoma ; Humans ; Keratoconus ; Keratoplasty, Penetrating ; Rejection (Psychology) ; Retrospective Studies ; Transplants

PURPOSE: To report four cases of split cornea transplantation involving separate Descemet membrane keratoplasty and Deep anterior lamella keratoplasty from a single cornea. CASE SUMMARY: Four donor corneas were separated into the endothelium and other layers. The endothelial layers were transplanted into 4 pseudophakic bullous keratopathy patients, and the other layers were stored in corneal storage media. Deep anterior lamella keratoplasties were performed with the stored corneas in 2 lipid keratopathy and 2 keratoconus patients. Postoperatively, all grafted corneas were stable. CONCLUSIONS: The authors report the first 4 cases of split cornea transplantation in Korea, which is experiencing a shortage of donated corneas. Split cornea transplantation will be of benefit to a large number of patients by separating a single cornea into separate layers to be implanted into two patients.
Cornea* ; Corneal Transplantation* ; Descemet Membrane ; Endothelium ; Humans ; Keratoconus ; Korea ; Tissue Donors ; Transplants