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: 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 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: To analyze the Paecilomyces keratitis cases in Korea and compare cases from foreign literature. METHODS: The records of 3 patients diagnosed with Paecilomyces keratitis at our hospital and other reported cases in Korea were evaluated to examine the predisposing factors, clinical aspects, antifungal therapy, therapeutic surgery, and visual outcome and compared with previously reported foreign cases. RESULTS: In Korea, 1 patient was female, 4 patients were male and had predisposing factors including prior corneal trauma or surgery, except 1 spontaneous occurrence. All 5 eyes of 5 patients had poor initial visual acuity, less than finger count, and deep corneal infiltration. The patients were treated with multiple topical and systemic antifungal treatments such as intracameral or intrastromal voriconazole injections and required evisceration and penetrating keratoplasty. However, the final outcomes were unsatisfactory. Previously reported cases from foreign literature also had predisposing factors such as corneal surgery, trauma, and soft contact lens use. They were resistant to antifungal therapy and eventually led to surgeries such as penetrating keratoplasty and the final outcomes were poor. CONCLUSIONS: Frequently, Paecilomyces keratitis has direct risk factors and is resistant to many topical and systemic antifungal agents. In the majority of cases, therapeutic surgery was required and the final visual outcomes were poor. When Paecilomyces keratitis is suspected, we suggest aggressive therapy including intracameral and intravitreal injections of voriconazole in the initial treatment.
Antifungal Agents ; Causality ; Contact Lenses, Hydrophilic ; Corneal Ulcer ; Female ; Fingers ; Humans ; Intravitreal Injections ; Keratitis* ; Keratoplasty, Penetrating ; Korea* ; Male ; Paecilomyces* ; Risk Factors ; Visual Acuity

PURPOSE: To investigate the clinical features and prevalence of patients with laser iridotomy-induced bullous keratopathy in Korea. METHODS: Using a retrospective study, the patients with laser iridotomy-induced bullous keratopathy who underwent penetrating keratoplasty were selected. We investigated the duration from iridotomy to corneal decompensation, preoperative anterior chamber depth, axial length, keratometry, and survival time of the grafted cornea. The data were compared with the data of patients with pseudophakic bullous keratopathy as controls. RESULTS: Laser iridotomy-induced bullous keratopathy was found in 17 eyes, which represented 2.3% of penetrating keratoplasty cases (727) and 8.5% of bullous keratopathy cases (201), with a mean age of 66.9 years. The laser iridotomy-induced bullous keratopathy group showed a higher female ratio (15 out of 17), shorter mean axial length (22.09 +/- 0.79 mm) and anterior chamber depth (1.91 +/- 0.36 mm) than the control group (15 out of 50, 24.30 +/- 2.54 mm and 3.27 +/- 0.66 mm, respectively) with a statistical significance (p = 0.002, p < 0.001 and p < 0.001, respectively). Mean survival time of the grafted cornea was 39.9 +/- 8.6 months in the group of laser iridotomy-induced bullous keratopathy, which was shorter than the control group (47.8 +/- 3.1 months) without statistical significance (p = 0.47). CONCLUSIONS: In Korea, laser iridotomy-induced bullous keratopathy shows non-negligible prevalence and should be further investigated.
Anterior Chamber ; Cornea ; Female ; Humans ; Keratoplasty, Penetrating ; Korea* ; Prevalence ; Retrospective Studies ; Survival Rate ; Transplants

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

Artificial corneas have been developed as an alternative to natural donor tissue to replace damaged or diseased corneas. This study was conducted to evaluate the stability and biocompatibility of PHEMA-PMMA [poly (2-hydroxyl methacrylate)-poly (methyl methacrylate)] keratoprostheses in rabbits following penetrating keratoplasty. Sixteen male New Zealand White rabbits aged 16 weeks were divided into three groups. Group I and group II contained six rabbits each, while the control group had four rabbits. Experimental surgery was conducted under general anesthesia. The cornea was penetrated using an 8 mm diameter biopsy punch. In group I (core 5 mm & skirt 3 mm) and group II (core 6 mm & skirt 2 mm), the keratoprosthesis was placed into the recipient full thickness bed and sutured into position with double-layer continuous. In the control group, corneal transplantation using normal allogenic corneal tissue was performed with the same suture method. After four and eight weeks, keratoprosthesis devices were evaluated by histopathological analysis of gross lesions. Post-operative complications were observed, such as extrusion and infection in experimental groups. Most corneas were maintained in the defect site by double-layer continuous suture materials for 4 weeks and kept good light transmission. However, most artificial cornea were extruded before 8 weeks. Overall, combined PHEMA and PMMA appears to have sufficient advantages for production of artificial corneas because of its optical transparency, flexibility and other mechanical features. However, the stability and biocompatibility were not sufficient to enable application in humans and animals at the present time using penetrating keratoplasty. Further studies are essential to improve the stability and biocompatibility with or without other types of keratoplasty.
Anesthesia, General ; Animals ; Biopsy ; Cornea ; Corneal Transplantation ; Humans ; Keratoplasty, Penetrating* ; Male ; Methods ; Pliability ; Polyhydroxyethyl Methacrylate ; Polymethyl Methacrylate ; Rabbits* ; Sutures ; Tissue Donors