[Fibrin glue-assisted lamellar keratoplasty for the treatment of corneal ulcer].

OBJECTIVE: To investigated the feasibility of fibrin glue-assisted sutureless lamellar keratoplasty (LK) in patients with corneal ulcer. METHODS: Noncomparative interventional case series. In 21 eyes of 21 patients with terriens marginal degeneration (TMD) or corneal ulcer after trauma, sutureless lamellar keratoplasty (LK) using fibrin glue was performed. Postoperatively, the graft status, graft clarity, the visual prognosis and postoperative complications were recorded. RESULTS: There were 16 cases suffered with Terriens marginal degeneration (TMD) and 5 cases with corneal ulcer after foreign body removed. All the corneal ulcers were successfully healed after the procedure, the operative complications included corneal perforation during operation in 1 case, recurrence of TMD in 1 case and graft opacity in 2 cases. There was no graft dislocation, hydrops between graft and recipient interface, secondary infection and graft rejection after surgery, 19 cases had improved best-corrected visual acuity (BCVA) while 2 cases had poor vision acuity due to graft opacity (t = -2.587, P = 0.018). CONCLUSION: Fibrin glue-assisted sutureless LK showed excellent graft stability in all patients.

[Non-Descemet stripping endothelial keratoplasty for treating iridocorneal endothelial syndrome in phakic eyes].

OBJECTIVE: To investigate the feasibility and clinical effects of non-Descemet stripping endothelial keratoplasty (nDSEK) on treating iridocorneal endothelial (ICE) syndrome in phakic eyes. METHODS: Retrospective noncomparative interventional case series. 7 patients (7 eyes) with ICE syndrome at the Affiliated Xiamen Eye Center of Xiamen University from January 2008 to December 2009 underwent non-Descemet stripping endothelial keratoplasty. All patients were followed up for 3 - 12 months, pre- and postoperative best corrected visual acuity (BCVA) were compared, the adherence of the donor disc to the recipient endothelium and postoperative donor disc dislocation were monitored during the follow-up period. Graft clearance and endothelial cell density (ECD) were observed, too. RESULTS: After nDSEK, no primary graft failures dislocation and decentered graft occurred during the follow-up period. Study group intraoperative complications included 3 case with elevated intraocular pressure 2 day postoperatively. Subepithelial haze, donor-recipient interface haze, and interface particles were observed in all measurable cases by in vivo laser confocal microscopy. Anterior segment optical coherence tomography and ultrasound biomicroscopy showed the adherence of the donor disc to the recipient endothelium and peripheral anterior synechiae were separated. All corneas remained clear during the follow-up. 6 patients had improved BCVA while 1 patient had the same BCVA. The reason for poor VA was optic atrophy due to glaucoma. Postoperative mean EDC was (2176.6 ± 267.6) cells/mm(2). CONCLUSIONS: nDSEK for iridocorneal endothelial (ICE) syndrome is feasible, technically easy, safe and effective. It can be one of the surgical treatment option for bullous keratopathy.

[Preliminary clinical study of non-Descemet stripping endothelial keratoplasty for bullous keratopathy].

OBJECTIVE: To investigate the feasibility and clinical effect of non-Descemet stripping endothelial keratoplasty for bullous keratopathy. METHODS: In the prospective consecutive case series, 6 patients (6 eyes) with bullous keratopathy at Affiliated Xiamen Eye Center of Xiamen University from September 2007 to January 2009 underwent non-Descemet stripping endothelial keratoplasty. During the surgical procedures, the recipient's Descemet membrane and endothelial layer were left untreated. The donor tissue disc consisting of posterior stroma and healthy endothelium from a donor cornea was implanted into the anterior chamber from a limbal tunnel incision, then unfolded and pressed against the recipient cornea with sterile air filled in anterior chamber. All patients were followed up for 6 - 20 months, pre- and postoperative best corrected visual acuity (BCVA) were compared, the adherence of the donor disc to the recipient endothelium and postoperative donor disc dislocation were monitored during the follow-up period. Graft clearance and endothelial cell density (ECD) were observed, too. RESULTS: Five donor disc were well adhered to the recipient endothelium and no graft dislocation occurred during the follow-up period. One case showed a narrow gap between the host endothelium and donor disc 1 day postoperatively. This patient was told to stay in prone position and the donor disc readhered well. All the grafts remained transparent until the latest follow-up. Five patients had improved BCVA while 1 patient had the same BCVA. The reason for poor VA was optic atrophy due to trauma. Postoperative mean EDC was (1648 + or - 384) cells/mm(2). CONCLUSIONS: Non-Descemet stripping endothelial keratoplasty for bullous keratopathy is feasible, technically easy, safe and effective. It can be one of the surgical treatment option for bullous keratopathy.