penetrating keratoplasty (PK) with imported donor corneas.METHODS: The eyes of patients who underwent primary PK with imported donor corneas were classified retrospectively into two groups according to a donor-age cutoff of 65 years. Primary outcome measures were rejection-free graft survival and graft survival. Cox proportional hazard regression analysis was used to assess the factors affecting graft survival. Survival analysis was performed using the Kaplan-Meier method, while differences between groups were examined using a log-rank test. A subgroup analysis of low- and high-risk eyes according to preoperative diagnosis was also performed.RESULTS: A total of 140 eyes from 138 patients (age, 58 ± 18 years) were enrolled. Cox regression analysis revealed that the donor age of 65 years or older group presented an increased risk of both graft rejection and failure. Survival analysis revealed that rejection-free graft survival and graft survival rates were higher in eyes in the donor age of less than 65 years group. Finally, in the subgroup analysis, both rejection-free graft survival and graft survival rates were significantly higher in the donor age of less than 65 years group than in the donor age of 65 years or older group, but only in the low-risk subgroup.CONCLUSIONS: Donor age may correlate with graft survival in primary PK performed with imported donor corneas. Donor age could be a considerable factor in primary PK with imported donor corneas, especially in preoperatively low-risk patients.]]>
Cornea ; Corneal Transplantation ; Diagnosis ; Graft Rejection ; Graft Survival ; Humans ; Keratoplasty, Penetrating ; Methods ; Outcome Assessment (Health Care) ; Retrospective Studies ; Risk Factors ; Tissue Donors ; Transplants

PURPOSE: We report a case of herpes simplex keratitis after Descemet membrane endothelial keratoplasty (DMEK). CASE SUMMARY: A 67-year-old male underwent DMEK in his left eye due to pseudophakic bullous keratopathy. One week after DMEK, re-bubbling was performed due to partial detachment of Descemet's membrane at the corneal periphery. After re-bubbling, the cornea remained clear and the patient's visual acuity gradually improved. Two months after DMEK, the patient presented with mild discomfort and decreased visual acuity. The cornea showed an irregular, narrow dendrite with an epithelial defect and surrounding opacity. After confirming that Descemet's membrane was attached, the patient was started on oral valacyclovir for suspected herpes keratitis. Herpes simplex virus type 1 was eventually identified by polymerase chain reaction. The corneal lesion resolved after three weeks of antiviral treatment. CONCLUSIONS: Similar to penetrating keratoplasty, DMEK can trigger outbreaks of herpes simplex keratitis. Herpes simplex keratitis should remain on the clinician's differential diagnosis for patients who present with a corneal epithelial irregularity and decreased visual acuity following DMEK.
Aged ; Cornea ; Corneal Transplantation ; Dendrites ; Descemet Membrane ; Diagnosis, Differential ; Disease Outbreaks ; Herpes Simplex ; Herpesvirus 1, Human ; Humans ; Keratitis ; Keratitis, Herpetic ; Keratoplasty, Penetrating ; Male ; Polymerase Chain Reaction ; Visual Acuity

OBJECTIVE: To investigate the effects of corneal thickness distribution and apex position on postoperative refractive status after full-bed deep anterior lamellar keratoplasty (FBDALK). METHODS: This is a retrospective analysis of patients who were diagnosed with advanced keratoconus between 2011 and 2014 in our hospital. The base of the cone in all patients did not exceed the central cornea at a 6-mm range. The FBDALK was performed by a same surgeon. All patients had a complete corneal suture removal and the follow-up records were intact. Patients who had graft-bed misalignment or who were complicated with a cataract or glaucoma were excluded. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), and Pentacam examination data were recorded at two years postoperatively. The recorded data included the superior-inferior (S-I) and nasal-temporal (N-T) corneal thickness differences in 2, 4, 6, and 8 mm diameter concentric circles with the corneal apex as the center (S-I_{2 mm}, S-I_{4 mm}, S-I_{6 mm}, S-I_{8 mm}, N-T_{2 mm}, N-T_{4 mm}, N-T_{6 mm}, and N-T_{8 mm}), the linear, X-axis, and Y-axis distance between the corneal pupillary center and the cornea apex, total corneal astigmatism at a zone of 3 mm diameter from the corneal apex (TA_{3 mm}), the astigmatic vector values J₀ and J₄₅, and the corneal total higher-order aberration for 3 and 6 mm pupil diameters (HOA_{3 mm} and HOA_{6 mm}). Statistical analysis was performed by SPSS 15.0. RESULTS: A total of 47 eyes of 46 patients met the criteria and were included in this study. The mean follow-up time was (28±7) months. The mean UCVA was 0.45±0.23 (logMAR) (MAR: minimum angle of resolution) and the mean BSCVA was 0.19±0.15 (logMAR), which were all significantly positively correlated with postoperative TA_{3 mm} and HOA_{3 mm}. The mean S-I corneal thickness differences were (44.62±37.74) μm, and the mean N-T was (38.57±32.29) μm. S-I_{2 mm} was significantly positively correlated with J₀ (r=0.31), J₄₅ (r=0.42), HOA_{3 mm} (r=0.37), and HOA_{6 mm} (r=0.48). S-I_{4 mm} and S-I_{8 mm} were significantly positively correlated with HOA_{3 mm} (r=0.30, r=0.40) and HOA_{6 mm} (r=0.46, r=0.35). The X-axis distance between corneal pupillary center and corneal apex was significantly positively correlated with J₄₅ (r=0.29). CONCLUSIONS In patients with advanced keratoconus after FBDALK, the unevenly distributed thickness at corneal pupillary area and the misalignment of corneal apex and pupillary center might cause significant regular and irregular astigmatism, which affected the postoperative visual quality.
Adolescent ; Adult ; Cornea/surgery* ; Corneal Transplantation/methods* ; Cryopreservation ; Female ; Follow-Up Studies ; Humans ; Keratoconus/diagnosis* ; Keratoplasty, Penetrating/methods* ; Male ; Retrospective Studies ; Visual Acuity ; Young Adult

PURPOSE: To report the resolution of a massive suprachoroidal hemorrhage after penetrating keratoplasty by sclerotomy. CASE SUMMARY: A 64-year-old man with a corneal opacity in the left eye underwent penetrating keratoplasty. On the first postoperative day, a massive suprachoroidal hemorrhage was detected. After two surgical drainage procedures, the suprachoroidal hemorrhage subsided and the graft survived. His visual acuity was 20/240 two months post-operation. CONCLUSIONS: We report a patient with massive suprachoroidal hemorrhage after penetrating keratoplasty that was improved by surgical drainage procedures.
Corneal Opacity ; Corneal Transplantation ; Drainage ; Hemorrhage* ; Humans ; Keratoplasty, Penetrating* ; Middle Aged ; Transplants ; Visual Acuity

PURPOSE: To report a case of penetrating keratoplasty and cataract surgery for improving visual acuity in an adult with Peters' anomaly. CASE SUMMARY: A 70-year-old female patient presented with decreased visual acuity for a few years. The patient had a history of Peters' anomaly in both eyes and evisceration surgery of the right eye 4 years prior to presentation. The patient's visual acuity was measured as finger count 20 cm at the time of visitation due to Peters' anomaly and brunescent cataract. In the slit lamp examination, irregular margin corneal opacity with anterior synechiae was observed in the center of the cornea, while the peripheral cornea was relatively normal. Penetrating keratoplasty and cataract surgery were performed, and visual acuity improved by 0.04 at 1 week, 0.04 at 1 month, and 0.16 at 4 months after surgery. Visual acuity was measured using a Snellen chart, and the intraocular pressure was maintained within the normal range of 17-20 mmHg. CONCLUSIONS: If peripheral corneal invasion is not severe in adults with Peters' anomaly, penetrating keratoplasty and cataract surgery can be performed for the purpose of improving visual acuity.
Adult ; Aged ; Cataract* ; Cornea ; Corneal Opacity ; Female ; Fingers ; Humans ; Intraocular Pressure ; Keratoplasty, Penetrating* ; Reference Values ; Slit Lamp ; Visual Acuity*

PURPOSE: We report a case of spontaneous corneal perforation combined with primary pterygium. CASE SUMMARY: A 66-year-old male presented with a foreign body sensation in his right eye. He had no systemic or ocular inflammatory diseases. He had undergone penetrating keratoplasty following amniotic membrane transplantation for corneal perforation at 1 day after pterygium excision in his left eye. The uncorrected visual acuity (UCVA) and intraocular pressure (IOP) in his right eye were 0.8 and 2 mmHg, respectively. Active leakage of an aqueous humor on the head of the pterygium was found on slit lamp examination. With the impression of spontaneous corneal perforation combined with primary pterygium, emergent amniotic membrane transplantation was performed. Diffuse corneal thinning around the 2 mm-sized perforation site was found 3mm away from the limbus in the 5 o'clock after removing the pterygium. The perforation site was covered with amniotic membrane after applying fibrin glue. UCVA and IOP in his right eye were 1.0 and 9 mmHg, respectively, at postoperative 6 months. No definite recurrence of pterygium or additional corneal perforation was found. CONCLUSIONS: Spontaneous corneal perforation may be related to primary pterygium.
Aged ; Amnion ; Aqueous Humor ; Corneal Perforation* ; Fibrin Tissue Adhesive ; Foreign Bodies ; Head ; Humans ; Intraocular Pressure ; Keratoplasty, Penetrating ; Male ; Pterygium* ; Recurrence ; Sensation ; Slit Lamp ; Visual Acuity

PURPOSE: To report a case of cytomegalovirus (CMV) corneal endotheliitis following penetrating keratoplasty. CASE SUMMARY: A 45-year-old male with a history of re-penetrating keratoplasty due to corneal opacity and graft failure after previous penetrating keratoplasty of his right eye in April 2014, visited our clinic for intermittent injection of the right eye for several weeks (7 months postoperative). Corneal edema, diffuse keratic pigmentation and anterior chamber reaction with decreased endothelial cell density were observed in his right eye using the slit lamp examination. Seven months after keratoplasty, corneal graft rejection were determined but clinical findings showed features of CMV-related corneal endotheliitis. Under the impression of CMV corneal endotheliitis, diagnostic paracentesis was performed for CMV real time polymerase chain reaction (RT-PCR). Additionally, the patient was admitted for intravenous ganciclovir and topical ganciclovir therapy. The next day, the RT-PCR results confirmed CMV infection. After 2 weeks of intravenous ganciclovir treatment, the patient was discharged and prescribed oral ganciclovir for 1 month. A month later, the coin-shaped corneal lesion nearly disappeared. There was no evidence of complication or recurrence. CONCLUSIONS: CMV corneal endotheliitis typically presents with coin-shaped keratic pigmentation and can be confirmed with RT-PCR using aqueous humor collected from the anterior chamber. Due to the long period of systemic and topical steroid therapy, the risk of viral endotheliitis is relatively high in patients with a history of penetrating keratoplasty. Corneal graft rejection is similar to corneal endotheliitis in symptoms and clinical features such as ciliary injection, decreased visual acuity, corneal edema or anterior chamber reaction. In patients after penetrating keratoplasty, CMV RT-PCR should be considered if the clinical features suggest viral endotheliitis.
Anterior Chamber ; Aqueous Humor ; Corneal Edema ; Corneal Opacity ; Corneal Transplantation ; Cytomegalovirus* ; Endothelial Cells ; Ganciclovir ; Graft Rejection* ; Humans ; Keratoplasty, Penetrating ; Male ; Middle Aged ; Paracentesis ; Pigmentation ; Real-Time Polymerase Chain Reaction ; Recurrence ; Slit Lamp ; Transplants* ; Visual Acuity

PURPOSE: To report a case treated with therapeutic keratoplasty using a cryo-preserved cornea in a patient with Candida albicans keratitis. CASE SUMMARY: A 77-year-old female visited our clinic because of left ocular pain and visual disturbance for 3 days. Microscopic slit lamp examination revealed a 1.2 mm sized round corneal epithelial defect with deep stromal infiltration, brownish pigmentation and signs of inflammation with cyclitic membranes in the anterior chamber. On suspicion of Candida keratitis, we performed penetrating keratoplasty using a cryo-preserved donor cornea in Optisol-GS® (Bausch & Lomb, Irvine, CA, USA) solution with excision of the infected iris and colony of the anterior chamber. After the procedure, injection of intravitreal or intracameral amphotericin B and voriconazole were administered alternately. At 2 weeks after the second surgery, infection signs disappeared. At the follow-up in the outpatient clinic, signs of infection were not observed. CONCLUSIONS: Therapeutic keratoplasty using a cryo-preserved donor cornea can be an immediate and effective therapeutic strategy for Candida albicans keratitis.
Aged ; Ambulatory Care Facilities ; Amphotericin B ; Anterior Chamber ; Candida albicans* ; Candida* ; Cornea* ; Corneal Transplantation* ; Female ; Follow-Up Studies ; Humans ; Inflammation ; Iris ; Keratitis* ; Keratoplasty, Penetrating ; Membranes ; Pigmentation ; Slit Lamp ; Tissue Donors ; Voriconazole

No abstract available.
Adult ; Corneal Dystrophies, Hereditary/physiopathology/*surgery ; Female ; Humans ; Keratoplasty, Penetrating/*methods ; Male ; Middle Aged ; Visual Acuity/*physiology

PURPOSE: To compare 2-year clinical outcomes of Descemet's stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) in patients with bullous keratopathy. METHODS: A retrospective chart review was performed to obtain 2 years of follow-up data of DSAEK or PK at a single center from March 2009 to September 2012. The study comprised 15 eyes of DSAEK and 11 eyes of PK. Outcome measures included best-corrected visual acuity (BCVA), spherical and keratometric changes, central corneal thickness, endothelial cell density, intraocular pressure, and postoperative complications. Graft survival rate was assessed by Kaplan-Meier survival analysis. RESULTS: There were no differences in patient baseline characteristics between the two groups. At postoperative 2 years, better BCVA of 0.69 ± 0.51 logarithm of the minimum angle of resolution (logMAR) was found after DSAEK compared to 0.88 ± 0.48 logMAR after PK. Refractive cylinder in DSAEK and PK was −2.60 ± 1.53 and −6.00 ± 1.05 diopters (D), respectively, and keratometric cylinder was 3.27 ± 3.70 and 6.34 ± 3.51 D, respectively, at postoperative 2 years. The difference of mean spherical equivalents between postoperative 1 month and 2 years was 0.84 D after DSAEK and 2.05 D after PK. A hyperopic shift of 1.17 D was present after 2 years of DSAEK. The mean endothelial cell density at postoperative 2 years was 1,548 ± 456 cells/mm² for DSAEK and 1,052 ± 567 cells/mm² for PK, with a cell loss of 19.96% vs. 52.38%, respectively when compared to postoperative 1 month. No significant difference in central corneal thickness was found between DSAEK and PK (592 ± 75 vs. 563 ± 90 µm, respectively). Finally, the 2-year survival rate did not differ significantly between DSAEK and PK (93.3% vs. 81.8%, respectively, p = 0.344). CONCLUSIONS: Compared to PK, DSAEK provided more stable refractive errors with better visual outcome, lower endothelial cell loss, and a lower rate of graft rejection at postoperative 2 years in patients with bullous keratopathy.
Cornea/diagnostic imaging/*surgery ; Corneal Diseases/diagnosis/*surgery ; Descemet Stripping Endothelial Keratoplasty/*methods ; Female ; Follow-Up Studies ; Graft Survival ; Humans ; Keratoplasty, Penetrating/*methods ; Male ; Middle Aged ; *Refraction, Ocular ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Visual Acuity