Trends in corneal transplantation: indications and techniques.

PURPOSE OF REVIEW: To describe trends in corneal transplantation surgery, including indications for surgery, evolution of lamellar keratoplasty, current surgical techniques, and future directions. RECENT FINDINGS: Over the past decade, anterior and posterior lamellar keratoplasty have begun to supplant penetrating keratoplasty. Surgical techniques continue to change and improve outcomes. In recent years, Descemet membrane endothelial keratoplasty (DMEK) has gained interest as it eliminates the corneal stromal interface, which may limit visual acuity after Descemet stripping automated endothelial keratoplasty. Despite the promising results with improved visual acuity and decreased rejection, the technical challenges associated with DMEK have limited widespread acceptance. With technical refinements and more eye banks providing precut tissue for both Descemet stripping automated endothelial keratoplasty and DMEK, it is likely both procedures will continue to increase over time. SUMMARY: Corneal transplantation has evolved rapidly over the past decade, from full-thickness penetrating keratoplasty towards lamellar keratoplasty to only remove and replace damaged layers of the cornea. Achieving minimal induced astigmatism with excellent visual acuity remains a challenge in corneal transplantation. Further refinements in surgical technique may help improve technical challenges and visual outcomes. In this article, we review changing trends in corneal transplantation and highlight developing medical treatments that may be available in the future.

Tissue Characteristics and Reported Adverse Events After Corneal Transplantation.

PURPOSE: To determine whether donor or tissue characteristics of corneas for transplantation are predictive of reported adverse events occurring in the early postoperative period. METHODS: We compared preoperative donor and tissue characteristics of corneal tissues with or without reported adverse events from 2007 to 2011. Adverse event categories included primary graft failure, infection, surgical causes, recipient-related etiologies, and other causes. We included corneas transplanted via penetrating keratoplasty (PK) and endothelial keratoplasty (EK). RESULTS: Of 20,431 tissues included, there were 251 (1.2%) reported adverse events. Among all transplanted tissues, 67% were used for PK, and 33% were used for EK. The adverse event occurrence rate was 0.78% in PK versus 2.12% in EK (P < 0.0001). The donor characteristics associated with adverse events were male gender (P = 0.01) and cancer history (P = 0.03), which were associated with primary graft failure. In PK, the most frequently reported causes within 106 adverse events were recipient-related causes (n = 41, 0.30% of total PK tissues) and infection (n = 31, 0.23%). In EK, the most frequently reported causes within 145 adverse events were surgical complications (n = 72, 1.05% of total EK tissues) and primary graft failure (n = 41, 0.60%). CONCLUSIONS: The rate of reported adverse events was low. Adverse events more commonly occurred after EK. Increased rate of primary graft failure was associated with male donors and donors with a cancer history. Postcut tissue thickness, only in the year 2007, was the sole tissue characteristic associated with adverse events.

Orbital myeloid sarcoma in an adult with acute myeloid leukemia, FAB M1, and 12p-deletion.

A 49-year-old woman with acute myeloid leukemia, FAB M1 subtype, and 12p deletion, presented with progressive right proptosis and diplopia for 1 week. Orbital CT revealed a homogenously enhancing, orbital mass engulfing the inferior rectus muscle. Histopathology revealed myeloid sarcoma for which she underwent external beam radiotherapy. Subsequently, there was no sign of local recurrence, but she succumbed to leukemia involving the central nervous system. This is the first case, to the authors' knowledge, of an orbital sarcoma of FAB M1 myeloblasts bearing a 12p deletion.