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

This study was conducted to establish the feasibility of corneal transplantation using the big-bubble technique (BBT) to perform deep anterior lamellar keratoplasty (DALK) in three dogs. After the cornea was trephined 750 µm, 4 mL of air was injected, and the blanched stroma was removed to expose Descemet's membrane (DM). The donor corneal button, which was gently stripped off the DM, was sutured onto the bare DM of the recipient cornea. The dogs received topical antibiotics every 6 h for 7 days and 2% cyclosporine ointment every 12 h for 1 month. The eyes were examined post-operatively at 7, 14, 21, 28 and 150 days. The central portion of the transplanted cornea stayed transparent while corneal haze developed around the transplanted margin. Menace response was normal even though the transplanted cornea was edematous until 3 weeks after surgery. A marginal haze was rarely observed between the donor and recipient corneas at 150 days after the operation. A spotted haze developed in the central part of the deep stroma near the DM. Upon histopathological examination, the stroma and epithelium of the donor cornea had normal structures. Corneal transplantation using DALK with BBT can be performed in dogs preserving the healthy endothelium.
Animals ; Anti-Bacterial Agents ; Cornea ; Corneal Transplantation* ; Cyclosporine ; Descemet Membrane ; Dogs* ; Endothelium ; Epithelium ; Humans ; Tissue Donors

PURPOSE: To evaluate the clinical efficacy and shortcomings of neodymium-doped yttrium aluminum garnet (Nd-YAG) laser membranotomy in inadvertently retained host membrane. METHODS: Among 742 patients who underwent penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK) surgery at Seoul St. Mary's Hospital between January 2007 and May 2013 by a single surgeon, 10 patients had a thin, opaque membrane in the anterior chamber observed under slit lamp examination and both a subjective decrease in visual acuity and decrease i best corrected visual acuity. A single surgeon performed membranotomy using the Nd-YAG laser at 4.9 months after graft surgery. In this study we compared the differences in visual acuity, endothelial cell count and correlations between distance from donor endothelium and retained host membrane and endothelial loss before and after the graft surgery. RESULTS: Patients who had Nd-YAG laser membranotomy performed on the retained host membrane showed significant improvements in visual acuity (p = 0.039). Donor endothelial cell count was significantly reduced 1 month after Nd-YAG laser. The average distance between donor endothelium and retained host membrane was 712.0 +/- 217.5 microm. The distance and the decreased donor endothelial cell count were not statistically correlated (R2 = 0.39, p = 0.072). There were no significant complications after the laser membranotomy. CONCLUSIONS: Inadvertently retained host membrane forms close to the donor endothelium as identified on optical coherence tomography (OCT) images. Nd-YAG laser membranotomy significantly affected clear vision but endothelial cell count loss was also observed.
Aluminum ; Anterior Chamber ; Corneal Transplantation* ; Endothelial Cells ; Endothelium ; Humans ; Keratoplasty, Penetrating ; Lasers, Solid-State* ; Membranes* ; Seoul ; Tissue Donors ; Tomography, Optical Coherence ; Transplants ; Visual Acuity ; Yttrium

Porcine to rat corneal xenotransplantation resulted in severe inflammation and rejection of the corneal stroma, whereas an allograft showed mainly endothelial cell-associated rejection. We, therefore, investigated and compared the gene expression between porcine keratocytes and corneal endothelial cells. RNA was isolated from primary cultured porcine or human keratocytes and porcine corneal endothelial cells. Gene expression was comparatively analyzed after normalization with microarray method using Platinum pig 13 K oligo chip (GenoCheck Co., Ltd., Ansan, Korea). Real-time polymerase chain reaction (PCR) was performed for C1R, CCL2, CXCL6, and HLA-A in porcine keratocytes and corneal endothelial cells. As a result, upregulated expression more than 2 folds was observed in 1,162 genes of porcine keratocytes versus porcine endothelial cells. Among the immune-regulatory genes, SEMA3C, CCL2, CXCL6, F3, HLA-A, CD97, IFI30, C1R, and G1P3 were highly expressed in porcine keratocytes, compared to porcine corneal endothelial cells or human keratocytes. When measured by real-time PCR, the expression of C1R, CCL2, and HLA-A was higher in porcine keratocytes compared to that in porcine corneal endothelial cells. In conclusion, the increased expression of C1R, CCL2, and HLA-A genes in porcine keratocytes might be responsible for the stromal rejection observed in a porcine to rat corneal xenotransplantation.
Animals ; Cells, Cultured ; Chemokine CCL2/metabolism ; Complement C1r/metabolism ; Corneal Transplantation/*immunology/pathology ; Endothelium, Corneal/*metabolism/pathology ; *Gene Expression Profiling ; Graft Rejection/*immunology/pathology ; HLA-A Antigens/metabolism ; Humans ; Keratinocytes/*metabolism ; Oligonucleotide Array Sequence Analysis ; Rats ; Reverse Transcriptase Polymerase Chain Reaction ; Swine ; Transplantation, Heterologous ; Up-Regulation

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 two cases of femtosecond laser-assisted small incision deep lamellar endothelial keratoplasty (DLEK) for patients with corneal endothelial decompensation by Fuchs dystrophy and glaucoma METHODS: Femtosecond laser (IntraLase(R); IntraLase Corp., Irvine, CA) with 15 kHz of repetition rate, was used for a 9.5 mm diameter by 400 micrometer thickness donor corneal lamellar dissection. RESULTS: In Case 1, the graft was clear and compact without interface haze, Orbscan showed smooth and regular corneal surface, specular microscopy was unremarkable without sign of corneal endothelial damage, and Optical coherence tomography showed uniform graft well attached to recipient stroma with minimal interface reflection at 2 months postoperation. In Case 2, the graft was clear and compact with minimal interface haze at 1 month postoperation. Femtosecond laser-assisted small incision DLEK was safe and technically feasible in our cases; however, further evaluation is required to determine long-term effects.
Aged ; Aged, 80 and over ; Corneal Edema/*surgery ; Corneal Surgery, Laser/*methods ; Corneal Topography ; Corneal Transplantation/*methods ; Endothelium, Corneal/*transplantation ; Female ; Fuchs' Endothelial Dystrophy/*surgery ; Humans ; Male ; Tomography, Optical Coherence ; Visual Acuity

PURPOSE: To report two cases of femtosecond laser-assisted small incision deep lamellar endothelial keratoplasty (DLEK) for patients with corneal endothelial decompensation by Fuchs dystrophy and glaucoma METHODS: Femtosecond laser (IntraLase(R); IntraLase Corp., Irvine, CA) with 15 kHz of repetition rate, was used for a 9.5 mm diameter by 400 micrometer thickness donor corneal lamellar dissection. RESULTS: In Case 1, the graft was clear and compact without interface haze, Orbscan showed smooth and regular corneal surface, specular microscopy was unremarkable without sign of corneal endothelial damage, and Optical coherence tomography showed uniform graft well attached to recipient stroma with minimal interface reflection at 2 months postoperation. In Case 2, the graft was clear and compact with minimal interface haze at 1 month postoperation. Femtosecond laser-assisted small incision DLEK was safe and technically feasible in our cases; however, further evaluation is required to determine long-term effects.
Aged ; Aged, 80 and over ; Corneal Edema/*surgery ; Corneal Surgery, Laser/*methods ; Corneal Topography ; Corneal Transplantation/*methods ; Endothelium, Corneal/*transplantation ; Female ; Fuchs' Endothelial Dystrophy/*surgery ; Humans ; Male ; Tomography, Optical Coherence ; 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: 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

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