A Novel Technique of Penetrating Keratoplasty to Prevent Intraocular Contents Extrusion for Infectious Keratitis

Overview

Journal BMC Ophthalmol

Publisher Biomed Central

Specialty Ophthalmology

Date 2023 Jul 17

PMID 37460970

Authors

Yukun Yang

Qian Kang

Hao Lian

Wei Qi

Duanrong Cao

Xiaoming Yao

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the safety and the effectiveness of our novel penetrating keratoplasty for infectious keratitis.

Methods: Retrospective, noncomparative, interventional case series of patients with infectious keratitis who received the novel penetrating keratoplasty technique were analyzed. A prepared plastic sheet was located between the diseased cornea and iris-lens diaphragm. After the diseased lesions were removed, the graft was positioned on the plastic sheet and sutured to the recipient bed. The plastic sheet was pulled out from the anterior chamber before the all interrupted sutures were placed. The intra- and post-operative complications, the outcome of the graft and the number of corneal endothelial cells were analyzed.

Results: A total of 82 eyes of 82 patients was included. The mean follow-up period was 29 ± 16 months (range from 13 to 45 months). No intraocular content extrusion, simultaneous cataract extraction and suprachoroidal hemorrhage occurred. Direct contact between the infectious cornea and the graft was successfully avoided. Greater than expected endothelial cell reduction or complications were not found.

Conclusions: This modified technique effectively prevents the extrusion of intraocular contents while avoiding the direct contact with donor endothelium during the procedure. The occurrence rate of complications such as endothelial cell loss is not higher than the conventional methods.

References

Kornmann H, Gedde S . Glaucoma management after corneal transplantation surgeries. Curr Opin Ophthalmol. 2015; 27(2):132-9. PMC: 5584078. DOI: 10.1097/ICU.0000000000000237. View

Ingraham H, Donnenfeld E, Perry H . Massive suprachoroidal hemorrhage in penetrating keratoplasty. Am J Ophthalmol. 1989; 108(6):670-5. DOI: 10.1016/0002-9394(89)90859-3. View

Rathi V, Krishnamachary M, Gupta S . Cataract formation after penetrating keratoplasty. J Cataract Refract Surg. 1997; 23(4):562-4. DOI: 10.1016/s0886-3350(97)80214-3. View

Rezende R, Uchoa U, Raber I, Rapuano C, Laibson P, Cohen E . New onset of herpes simplex virus epithelial keratitis after penetrating keratoplasty. Am J Ophthalmol. 2004; 137(3):415-9. DOI: 10.1016/j.ajo.2003.09.057. View

Raj A, Bahadur H, Dhasmana R . Outcome of therapeutic penetrating keratoplasty in advanced infectious keratitis. J Curr Ophthalmol. 2018; 30(4):315-320. PMC: 6276621. DOI: 10.1016/j.joco.2018.04.001. View

Kharod-Dholakia B, Randleman J, Bromley J, Stulting R . Prevention and treatment of corneal graft rejection: current practice patterns of the Cornea Society (2011). Cornea. 2015; 34(6):609-14. DOI: 10.1097/ICO.0000000000000403. View

Lopez-Plandolit S, Etxebarria J, Acera A, Castiella G, Duran J . [Protected penetrating keratoplasty: surgical technique and endothelial response]. Arch Soc Esp Oftalmol. 2008; 83(4):231-6. DOI: 10.4321/s0365-66912008000400005. View

Matoba A, Barrett R, Lehmann A . Cure Rate of Fungal Keratitis With Antibacterial Therapy. Cornea. 2017; 36(5):578-580. DOI: 10.1097/ICO.0000000000001170. View

Chen W, Ren Y, Zheng Q, Li J, Waller S . Securing the anterior chamber in penetrating keratoplasty: an innovative surgical technique. Cornea. 2013; 32(9):1291-5. DOI: 10.1097/ICO.0b013e31829954c5. View

10.

Bajracharya L, Gurung R . Outcome of therapeutic penetrating keratoplasty in a tertiary eye care center in Nepal. Clin Ophthalmol. 2015; 9:2299-304. PMC: 4676621. DOI: 10.2147/OPTH.S92176. View

11.

Said O, Saleh M, Omar A, Abdou A, Riad Mostafa A . Topical Difluprednate for Early Corneal Graft Rejection After Penetrating Keratoplasty. Clin Ophthalmol. 2020; 14:3495-3498. PMC: 7602884. DOI: 10.2147/OPTH.S267888. View

12.

Chu T, Green R . Suprachoroidal hemorrhage. Surv Ophthalmol. 1999; 43(6):471-86. DOI: 10.1016/s0039-6257(99)00037-5. View

13.

Price Jr F, Whitson W, Ahad K, Tavakkoli H . Suprachoroidal hemorrhage in penetrating keratoplasty. Ophthalmic Surg. 1994; 25(8):521-5. View

14.

Moon J, Yoon C, Kim M, Oh J . The Incidence and Outcomes of Recurrence of Infection after Therapeutic Penetrating Keratoplasty for Medically-Uncontrolled Infectious Keratitis. J Clin Med. 2020; 9(11). PMC: 7698699. DOI: 10.3390/jcm9113696. View

15.

Arslan O, Unal M, Arici C, Cicik E, Mangan S, Atalay E . Novel method to avoid the open-sky condition in penetrating keratoplasty: covered cornea technique. Cornea. 2014; 33(9):994-8. DOI: 10.1097/ICO.0000000000000186. View

16.

Song A, Deshmukh R, Lin H, Ang M, Mehta J, Chodosh J . Post-keratoplasty Infectious Keratitis: Epidemiology, Risk Factors, Management, and Outcomes. Front Med (Lausanne). 2021; 8:707242. PMC: 8292647. DOI: 10.3389/fmed.2021.707242. View

17.

Cheng Y, Visser N, Schouten J, Wijdh R, Pels E, van Cleynenbreugel H . Endothelial cell loss and visual outcome of deep anterior lamellar keratoplasty versus penetrating keratoplasty: a randomized multicenter clinical trial. Ophthalmology. 2010; 118(2):302-9. DOI: 10.1016/j.ophtha.2010.06.005. View

18.

Faktorovich E, Rabinowitz Y . Method for safer penetrating keratoplasty in patients with low scleral rigidity. J Cataract Refract Surg. 1999; 25(7):882-4. DOI: 10.1016/s0886-3350(99)00071-1. View