scholarly journals Application of benzonase in preparation of decellularized lamellar porcine corneal stroma for lamellar keratoplasty

2019 ◽  
Vol 107 (11) ◽  
pp. 2547-2555 ◽  
Author(s):  
Jing Liu ◽  
Zhihan Li ◽  
Jie Li ◽  
Zuguo Liu
Keyword(s):  
Corneal Stroma ◽  
Lamellar Keratoplasty

Natural cross-linker-stabilized acellular porcine corneal stroma for lamellar keratoplasty

2020 ◽  
Vol 114 ◽  
pp. 270-284
Author(s):  
Hua Li ◽  
Long Zhao ◽  
Fuyan Wang ◽  
Hongwei Wang ◽  
Muchen Dong ◽  
...  
Keyword(s):  
Corneal Stroma ◽  
Lamellar Keratoplasty ◽  
Cross Linker ◽  
Natural Cross

scholarly journals Lamellar Keratoplasty: A Literature Review

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Ladan Espandar ◽  
Alan N. Carlson
Keyword(s):  
Literature Review ◽  
Graft Rejection ◽  
Corneal Stroma ◽  
Surgical Instruments ◽  
Lamellar Keratoplasty ◽  
Endothelial Keratoplasty ◽  
New Techniques ◽  
Posterior Lamellar Keratoplasty ◽  
Acceptable Alternative ◽  
Anterior Lamellar Keratoplasty

The concept of lamellar keratoplasty (LK) is not new. However, newer forms of lamellar keratoplasty techniques have emerged in the last decade or so revolving around the concept of targeted replacement of diseased corneal layers. These include anterior lamellar keratoplasty (ALK) techniques that aim to selectively replace diseased corneal stroma and endothelial keratoplasty techniques aiming to replaced damaged endothelium in endothelial disorders. Recent improvements in surgical instruments and introduction of new techniques as well as inherent advantages such as preservation of globe integrity and decreased graft rejection have resulted in the reintroduction of LK as an acceptable alternative to conventional PK. In this review, indications, benefits, limitations, and outcomes of various anterior and posterior lamellar keratoplasty techniques are discussed.

Remodelling of the Corneal Stroma After Lamellar Keratoplasty

Cornea ◽  
1994 ◽  
Vol 13 (1) ◽  
pp. 20-27 ◽  
Author(s):  
Andrew J. Quantock ◽  
Katherine L. Kratz-Owens ◽  
Daniel W. Leonard ◽  
Keith M. Meek ◽  
David J. Schanzlin
Keyword(s):  
Corneal Stroma ◽  
Lamellar Keratoplasty

scholarly journals Risk factors influencing survival of acellular porcine corneal stroma in infectious keratitis: a prospective clinical study

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Saiqun Li ◽  
Meng Li ◽  
Li Gu ◽  
Lulu Peng ◽  
Yuqing Deng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
Graft Survival ◽  
Graft Failure ◽  
Corneal Stroma ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Infectious Keratitis ◽  
Anterior Lamellar Keratoplasty

Abstract Background A worldwide lack of donor corneas demands the bioengineered corneas be developed as an alternative. The primary objective of the current study was to evaluate the efficacy of acellular porcine corneal stroma (APCS) transplantation in various types of infectious keratitis and identify risk factors that may increase APCS graft failure. Methods In this prospective interventional study, 39 patients with progressive infectious keratitis underwent therapeutic lamellar keratoplasty using APCS and were followed up for 12 months. Data collected for analysis included preoperative characteristics, visual acuity, graft survival and complications. Graft survival was evaluated by the Kaplan–Meier method and compared with the log-rank test. Results The percentage of eyes that had a visual acuity of 20/40 or better increased from 10.3% preoperatively to 51.2% at 12 months postoperatively. Twelve patients (30.8%) experienced graft failure within the follow-up period. The primary reasons given for graft failure was noninfectious graft melting (n = 5), and the other causes included recurrence of primary infection (n = 4) and extensive graft neovascularization (n = 3). No graft rejection was observed during the follow-up period. A higher relative risk (RR) of graft failure was associated with herpetic keratitis (RR = 8.0, P = 0.046) and graft size larger than 8 mm (RR = 6.5, P < 0.001). Conclusions APCS transplantation is an alternative treatment option for eyes with medically unresponsive infectious keratitis. Despite the efficacy of therapeutic lamellar keratoplasty with APCS, to achieve a good prognosis, restriction of surgical indications, careful selection of patients and postoperative management must be emphasized. Trial registration Prospective Study of Deep Anterior Lamellar Keratoplasty Using Acellular Porcine Cornea, NCT03105466. Registered 31 August 2016, ClinicalTrails.gov

12-Year Outcomes of Microkeratome-Assisted Anterior Lamellar Therapeutic Keratoplasty (ALTK) for Disorders of the Anterior Part of the Corneal Stroma – A Comparative Review of Adult and Children

2018 ◽  
Vol 235 (04) ◽  
pp. 404-408 ◽  
Author(s):  
Ivo Guber ◽  
Ciara Bergin ◽  
Philippe Othenin-Girard ◽  
Francis Munier ◽  
François Majo
Keyword(s):  
Contact Lenses ◽  
Surgical Complication ◽  
Anterior Part ◽  
Corneal Stroma ◽  
Lamellar Keratoplasty ◽  
Consecutive Series ◽  
Anterior Lamellar Keratoplasty ◽  
Comparative Review ◽  
The Mean

Abstract Purpose To report the visual outcomes and complications of automated anterior lamellar therapeutic keratoplasty (ALTK) in adults and children, and to examine these outcomes as a function of age and etiology. Methods A consecutive series of cases undergoing automated ALTK procedures performed at the Jules-Gonin Eye Hospital Lausanne, Switzerland, between June 2003 and January 2015. Only patients with at least 3 months of follow-up were included. Results There were 53 eyes (24 right) of 51 patients (17 female, 16 juvenile), with a mean age of 34.8 years (range from 3 months to 88 years), analyzed. The mean follow-up was 35 (± 26) months. Diagnosis in the adult (n = 37) vs. juvenile (n = 16) eyes was different: opacity following surgical complication 8 vs. 0, congenital 1 vs. 1, dystrophy 5 vs. 2, infection 12 vs. 5, keratectasia 3 vs. 0, trauma 7 vs. 0, tumor 1 vs. 3, and allergy 0 vs. 5. Visual impairment as a consequence of corneal scarring was the principle indication for surgery in both adult (70%; 26) and juvenile eyes (63%; 10); other indications were choristoma, dermoid, other tumors, astigmatism, and congenital opacity. In adult vs. juvenile eyes, the mean visual acuity (spectacle and contact lenses) was, at last visit, 0.55 vs. 0.45 LogMAR (p = 0.78), with a range of 100% to hand movements. Failure occurred in 6 (16%) vs. 2 (13%) cases and complications were observed in 14 (38%) vs. 9 (56%) cases, however, more surgical revision was required in juvenile eyes, 4 (11%) vs. 7 (43%) (p = 0.01, Fisher test). Conclusions This study shows that anterior lamellar keratoplasty in children retains good visual function when combined with adequate amblyopic therapy. However, the rate of complications is higher in juveniles and requires more intensive interdisciplinary follow-up.

A singular case of iatrogenic gas-filled double anterior chamber after DALK

2020 ◽  
pp. 112067212097361
Author(s):  
Fabrizio Gaetano Saverio Franco ◽  
Lidia Vicchio ◽  
Marco Branchetti ◽  
Roberto Vignapiano ◽  
Fabrizio Giansanti
Keyword(s):  
Anterior Chamber ◽  
Corneal Stroma ◽  
Healthy Woman ◽  
Spontaneous Resolution ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Descemet Membrane ◽  
Anterior Lamellar Keratoplasty ◽  
Wait And See ◽  
Descemet Membrane Detachment

Aim: To present a case of double anterior chamber after DALK and its surgical management. Case description: A 67-year-old healthy woman underwent deep anterior lamellar keratoplasty (DALK) in her right eye for keratoconus with the big-bubble technique. About 7 days after surgery a partial detachment of the Descemet membrane from the posterior corneal stroma was revealed using AS-OCT (double anterior chamber appearance). In spite of two injections in the anterior chamber of air and gas on the 7th and 9th post-operative days respectively, the double anterior chamber still persisted. Furthermore, both air and gas passed through the little perforation of the host Descemet membrane-endothelium complex and enlarged the space between the stroma and Descemet membrane. About 10 weeks after DALK, a spontaneous resolution of the double anterior chamber was observed. Conclusion: This case suggests that an injection of air or gas into the anterior chamber, to deal with a Descemet membrane detachment following perforation during DALK procedure, can enlarge the double anterior chamber by increasing the space between stroma and Descemet membrane. These cases can be managed with a “wait and see” strategy for a spontaneous resolution to Descemet membrane detachment.

scholarly journals Lamellar Keratoplasty Combined with Amniotic Membrane Transplantation for the Treatment of Corneal Perforations: A Clinical and In Vivo Confocal Microscopy Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Lan Ke ◽  
Dan Shen ◽  
Haoyu Wang ◽  
Chen Qiao ◽  
Qingyan Zeng
Keyword(s):  
Confocal Microscopy ◽  
Amniotic Membrane ◽  
Corneal Stroma ◽  
Lamellar Keratoplasty ◽  
Amniotic Membrane Transplantation ◽  
Corneal Perforation ◽  
In Vivo Confocal Microscopy ◽  
The Mean

Purpose. To evaluate the clinical and in vivo confocal microscopy outcome of lamellar keratoplasty combined with amniotic membrane transplantation for the treatment of corneal perforations. Methods. In this retrospective, noncomparative, and interventional case series, 13 eyes of 13 patients with corneal perforation were included. All eyes were treated with lamellar keratoplasty combined with amniotic membrane transplantation for corneal reconstruction. Age, underlying etiology, location, size of corneal ulcer, size of corneal perforation, hospitalization days and follow-up time, and corneal confocal microscopy were investigated. Aqueous leakage, anterior chamber formation, epithelial healing time, and visual acuity (VA) were monitored after operation. Results. The cause of corneal perforation (n = 13) was classified as infectious (n = 1) and noninfectious (n = 12). Most of the locations of corneal perforation were paracentral, and 2 of them were center. The anterior chambers were formed without aqueous leakage and other complications at postoperative day. The mean time of regained a smooth corneal surface was 7.5 ± 2.9 (ranging from 4 to 14) days. The mean hospitalization day was 13.1 ± 4.5 (ranging from 7 to 22) days. The mean follow-up time is 22.5 ± 14.5 (ranging from 4 to 43) months. The AM appeared as a high-reflective reflection in the corneal stroma after surgery about half a year and is almost transparent at about one year. Corneal stroma-derived cells were populated in the AM at about 1 month, increased at 2 months, and almost not obviously at 20 months postoperatively. The size and density of endothelial cells were stable after 1 year near the perforation site. The VA improved to varying degrees in 9 eyes, remained unchanged in 2 eyes, and decreased in 2 eyes. One eye recurrence and no side effects occurred during the follow-up time. Conclusion. Lamellar keratoplasty combined with amniotic membrane transplantation may be an alternative, safe, and effective surgical therapy in the treatment of corneal perforations in the absence of a fresh donor cornea. We recommend this surgery to treat with the size of corneal perforation of <4 mm in diameter no matter peripheral or central corneal perforation, especially who had immune-related diseases.

Ten-year outcomes of microkeratome-assisted lamellar keratoplasty for keratoconus

2020 ◽  
pp. bjophthalmol-2020-317253
Author(s):  
Angeli Christy Yu ◽  
Elena Franco ◽  
Lorenzo Caruso ◽  
James Myerscough ◽  
Rossella Spena ◽  
...  
Keyword(s):  
Endothelial Cell ◽  
Graft Failure ◽  
Cumulative Risk ◽  
Corneal Stroma ◽  
Case Series ◽  
Cell Loss ◽  
Lamellar Keratoplasty ◽  
Refractive Outcomes ◽  
Immunological Rejection

Background/AimsTo report the 10-year outcomes of modified microkeratome-assisted lamellar keratoplasty (LK) for keratoconus.MethodsIn this single-centre interventional case series, 151 consecutive eyes with keratoconus underwent modified microkeratome-assisted LK. Eyes with scars extending beyond the posterior half of the corneal stroma and preoperative thinnest-point pachymetry value of less than 300 μm were excluded. Outcome measures were best spectacle-corrected visual acuity (BSCVA), refractive astigmatism (RA), endothelial cell density, immunological rejection, ectasia recurrence and graft failure rates.ResultsBaseline BSCVA (0.89±0.31 logarithm of the minimum angle of resolution (logMAR)) significantly improved to 0.10±0.12 logMAR at year 3 (p<0.001), and remained stable up to 10 years. At 10 years, 94% of eyes saw ≥20/40, 61% saw ≥20/25 and 24% saw ≥20/20 Snellen BSCVA. At final follow-up, RA exceeding 4.5 dioptres was observed in 5 cases (4%). Endothelial cell loss was 25±17% at 1 year with an annual decline of 2% over 10 years. The 10-year cumulative risk for immunological rejection and graft failure was 8.5%, and 2.4%, respectively. No case developed recurrent ectasia at 10 years.ConclusionModified microkeratome-assisted LK results in stable visual and refractive outcomes with low rates of immunological rejection and graft failure in the absence of recurrence of ectasia for at least 10 years.

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