ABSTRACT
Background: There is a high risk of rejection of a corneal transplant known as a "rejection episode" in our Hospital conditioned by multiple variables. The aim of this article is to analyze the different risk factors of "corneal rejection episode" in post-transplant patients at one year of follow-up and in particular to consider the presence of donor blood incompatibility during the first year of post-surgical follow-up. Methods: A nested case-control study was designed in a cohort: observational, longitudinal, analytical and retrospective from year 2012 to 2013. We performed OR and logistic regression of the variables that influenced rejection. Results: We included 101 consecutive transplants from multiorgan donation. The variables that influenced the rejection episode were: preoperative high risk group, graft size, blood incompatibility, female gender and age over 60 years old. Other variables such as the presence of comorbidities, combined surgery, surgical time greater than one hour and postoperative complications did not show significant differences. Conclusions: It is advisable to perform routine blood compatibility to reduce the risk of rejection.
Introducción: Existe un elevado riesgo de rechazo de trasplante corneal conocido como "episodio de rechazo" en nuestro Hospital condicionado por múltiples variables. El objetivo de este trabajo fue analizar las diferentes causas de riesgo de episodio de rechazo corneal en pacientes postrasplantados a un año de seguimiento y en particular considerar la presencia con incompatibilidad sanguínea del donador durante el primer año de seguimiento posquirúrgico. Métodos: Se diseñó un estudio de casos y controles anidados en una cohorte: observacional, longitudinal, analítico y retrospectivo del año 2012 al 2013. Se realizó OR y regresión logística de las variables que influyeron en rechazo. Resultados: Se incluyeron 101 trasplantes consecutivos procedentes de donación multiorgánica. Las variables que influyeron en el episodio de rechazo fueron: grupo prequirúrgico de riesgo alto, tamaño del injerto, incompatibilidad sanguínea, género femenino y mayores de 60 años. Otras variables como la presencia de comorbilidades, cirugía combinada, tiempo quirúrgico mayor a una hora y complicaciones postquirúrgicas no mostraron diferencias significativas. Conclusiones: Es recomendable realizar de rutina la compatibilidad sanguínea para disminuir el riesgo de episodio de rechazo.
Subject(s)
Blood Group Incompatibility , Corneal Transplantation , Graft Rejection/etiology , Adult , Aged , Aged, 80 and over , Case-Control Studies , Female , Follow-Up Studies , Graft Rejection/diagnosis , Humans , Logistic Models , Male , Middle Aged , Odds Ratio , Outcome Assessment, Health Care , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: The cornea is the first tissue awaiting transplantation at a national level. It is imperative to train health personnel in procurement technique with excision of corneoscleral button in situ. The objective was to compare the quality of corneal tissue procured by social service medical interns and Ophthalmology residents in a third level hospital. METHODS: We performed a quasi-experimental pilot study with two groups: group 1, which included trained social service medical interns, and group 2, which included trained residents of Ophthalmology. RESULTS: 10 participants in two groups had a mean endothelial cell density of 2662.35 ± 223.92, a percentage of hexagonal cells of 53.89 ± 5.61 %, and a coefficient of variation of 0.43 ± 0.06 in group 1; also, and respectively, group 2 presented these results: 2656.44 ± 156.14, 64.15 ± 5.90 %, and 0.45 ± 0.06. The macroscopic and microscopic quality of procured corneal tissues was similar in both groups. Besides the learning curve and complications were minimal. CONCLUSION: All trained medical personnel acquired skills necessary to obtain optimal corneal tissue.
Subject(s)
Clinical Competence/statistics & numerical data , Cornea/surgery , Education, Medical, Continuing , Tissue and Organ Harvesting/education , Adult , Corneal Transplantation , Female , Humans , Internship and Residency , Learning Curve , Longitudinal Studies , Male , Mexico , Ophthalmology/education , Pilot Projects , Prospective Studies , Tissue and Organ Harvesting/methods , Tissue and Organ Harvesting/standardsABSTRACT
BACKGROUND: Penetrating keratoplasty is considered the most frequent and successfully performed organ transplantation. Indications of corneal transplantation have changed over time and they vary according to the country. Some risk factors for graft rejection, as age, corneal vascularization or ocular surgery, among others, have been identified. The aim was to identify the prognostic category, group and associated risk factors of patients registered in the database of corneal transplantation in the Centro Médico Nacional La Raza between 2011 and 2013. METHODS: Cross-sectional, analytical, observational, retrospective and prospective chart study, with therapeutic and optical purposes, of patients from the aforementioned database of corneal transplantation. RESULTS: We obtained 539 records. The most frequent diagnosis was keratoconus (29.1 %), followed by corneal scars (27.8 %), and pseudophakic bullous keratopathy (25.6 %). Of all patients, 57.5 % corresponded to the prognostic category 2, with a very good prognosis of corneal transparency. CONCLUSION: The most frequent diagnosis in the database of corneal transplant was keratoconus. It is necessary an update of the prognostic classification taking into account all known factors associated, in order to be more accuarte in the prognosis of corneal transplantation.
Introducción: la queratoplastía penetrante (QP) es considerada como el trasplante orgánico más frecuentemente realizado y con mayor éxito. Las indicaciones de trasplante de córnea han cambiado con el tiempo y varían en función del país. Se han identificado factores de riesgo de rechazo corneal, como edad, vascularización corneal, cirugías oculares, etcétera. El objetivo fue identificar la categoría pronóstica, el grupo de riesgo y los factores asociados de pacientes con trasplante de córnea del Centro Médico Nacional La Raza. Métodos: se hizo un estudio transversal, analítico, observacional y ambispectivo, con fines ópticos y terapéuticos, de pacientes de la base de datos de trasplante corneal registrados entre 2011 y 2013 en el centro médico mencionado. Resultados: se obtuvieron 539 registros. El diagnóstico más frecuente fue el queratocono (29.1 %), en segundo lugar el leucoma (27.8 %) y la queratopatía bulosa pseudofáquica (25.6 %) en tercero. El 57.5 % de los pacientes correspondieron a la categoría pronóstica 2, con pronóstico de transparencia corneal muy bueno. Conclusiones: el diagnóstico más frecuente en la base de datos de trasplante de córnea fue el queratocono. Es necesaria una actualización de la clasificación pronóstica con base en todos los factores asociados conocidos, a fin de ser más acertados en el pronóstico del TC.
Subject(s)
Corneal Diseases/diagnosis , Corneal Diseases/surgery , Corneal Transplantation , Adolescent , Adult , Aged , Aged, 80 and over , Child , Cross-Sectional Studies , Female , Humans , Male , Mexico , Middle Aged , Prognosis , Prospective Studies , Retrospective Studies , Tertiary Care Centers , Treatment Outcome , Young AdultABSTRACT
OBJECTIVE: to determine the frequency and clinical characteristics of patients with keratoconus and a corneal transplant (CT) at an ophthalmology reference hospital. METHODS: retrospective, cross-sectional, observational, descriptive study of 166 patients with diagnosis of keratoconus and CT. RESULTS: average age of 37.59 years, 97 males (58.43%), 69 females (41.56%). The primarily affected eye was the left one (95 cases, 57 %). Coef C -0.01265. The age at the keratoconus diagnosis was between 20 and 29 years (77 cases, 46.40 %), with an average of 24.5 years. The most frequent signs and symptoms were blurred vision: 140 (84.33 %), itching: 100 (60.24 %), photophobia: 20 (12.04 %). Associated systemic diseases: Down Syndrome 2 cases, (1.20 %), asthma 6 cases (3.61 %), atopic dermatitis 14 cases (8.43 %), allergic rhinitis 10 cases (6.02 %). Related ocular diseases: allergic conjunctivitis 72 cases (43.47 %). CONCLUSIONS: There is strong association between the corneal microtrauma secondary to itching resulting from allergic processes and keratoconus. A timely diagnosis is of great importance to diminish the progression to corneal scarring requiring a CT.
Subject(s)
Corneal Transplantation , Keratoconus/epidemiology , Keratoconus/surgery , Adolescent , Adult , Aged , Child , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
OBJECTIVE: to evaluate vascular involution of corneal neovessels followed by the application of photodynamic therapy (PDT) verteporfirina. METHODS: Prospective, longitudinal, case series. Fifty eyes of 49 candidate patients to partial penetrating keratoplasty (PPK) also called corneal transplant (CT) at risk of corneal neovascularization (CN) of two or more quadrants and which were previous treated with intravenous PDT. The monitoring was carried out with photographic control of the anterior segment assessing adverse effects and development of CN. RESULTS: The length of the CN before and after PDT were 4.39 ± 2.24 vs 3.71 ± 2.48 (p < 0.0001) respectively. This involution was maintained after two months of follow up. One eye (2 %) presented changes Keratometry (keratometric astigmatism). Of the total 45 (90 %) of patients who showed a reduction in the CN, had revascularization within the following six months of intervention. CONCLUSIONS: the PDT with verteporfirina is effective and safe for decreasing the length of the CN, without local and systemic adverse effects. However it is suggested to schedule the surgery two months after to permit revascularization.
Subject(s)
Corneal Neovascularization/drug therapy , Photochemotherapy , Photosensitizing Agents/therapeutic use , Porphyrins/therapeutic use , Female , Humans , Male , Middle Aged , Prospective Studies , VerteporfinABSTRACT
CLINICAL CASES: two cases reported presented corneal topography with peripheral inferior corneal slimming (pachymetry), flattening of superior and central meridian, high astigmatism against the rule, corroborating clinical pellucid marginal degeneration prognosis. A rheumatologist and a dermatologist confirmed primary and secondary Sjögren's syndrome in each case. CONCLUSIONS: In the cases studied, the pellucid marginal degeneration was presented with inferior corneal slimming, progressive irregular astigmatism and decreased visual acuity. However, the patients were treated for a long time only for dry eye. The association between pellucid marginal degeneration, primary Sjögren syndrome and secondary Sjögren syndrome has not been described. In the analyzed cases, both pathologies were observed and caused a bad prognosis because the treatment required is very difficult.
