Estudio comparativo en queratoplastia para queratocono entre las técnicas lamelar profunda de Anwar (big bubble) y penetrante procedente de conversión / Comparative study of keratoconus between Anwar's deep anterior lamellar keratoplasty versus converted penetrating keratoplasty

OBJETIVO: El propósito de este grupo de estudio fue comparar los resultados entre los procedimientos de queratoplastia lamelar profunda anterior (deep anterior lamellar keratoplasty [DALK]) y queratoplastia penetrante (penetrating keratoplasty [PK]) en pacientes con queratocono. DISEÑO: Estudio de cohorte retrospectivo. MÉTODO: Se analizaron los resultados de 90 DALK y 49 PK procedentes de reconversión en pacientes con queratocono. Todos los procedimientos fueron realizados por el mismo cirujano (R.D.) desde 2006 hasta 2011. Entre ambos grupos se comparó la agudeza visual a distancia corregida (AVCC), el astigmatismo, el tiempo de la primera refracción, la paquimetría, el recuento de células endoteliales y las complicaciones postoperatorias. RESULTADOS: La media de edad fue de 28,2 años para DALK y de 31,7 años para PK (p = 0,17). El seguimiento medio fue de 14,7 meses para DALK y 19,4 meses para PK (p = 0,13). No hubo diferencia significativa alguna entre los grupos de PK y DALK en la media postoperatoria de AVCC (LogMAR) (0,17 frente a 0,17; p = 0,59), astigmatismo refractivo (-3,19 frente a -3,01 dioptrías; p = 0,65) ni en el tiempo de la primera refracción subjetiva (60,5 frente a 68 días; p = 0,50). Las principales complicaciones postoperatorias fueron 8% de rechazo endotelial en el grupo PK y 10% de vascularización de la interfaz en el grupo DALK. CONCLUSIONES: La única diferencia entre ambos grupos fue la neovascularización estromal profunda en DALK y el rechazo endotelial en PK, por lo que el procedimiento DALK debe ser considerado como primera opción en el tratamiento de pacientes con queratocono

OBJECTIVE: To compare outcomes between penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. DESIGN: Retrospective cohort study. METHODS: Data of 90 DALK and 49 procedures from conversion to PK, performed by a single surgeon (R.D.) from 2006 to 2011 were analysed. Outcomes on corrected distance visual acuity (BCVA), astigmatism, time to first refraction, pachymetry, endothelial count cell, and postoperative complications were compared between these groups. RESULTS: The mean age of the patients who underwent DALK and PK was 28.2 and 31.7 years, respectively (P=.17). The mean follow up for DALK and for the PK group was 14.7 and 19.4 months, respectively (P=.13). There was no significant difference between PK and DALK groups in the mean postoperative for: BCVA (LogMAR) (0.17 vs. 0.17; P=.59); refractive astigmatism (-3.19 vs.-3.01 diopters; P=.65), and time for the first subjective refraction (60.5 versus 68 days; P=.50). Main postoperative complications were 8% of endothelial rejection in PK group and 10% of deep stromal vascularization in DALK group. CONCLUSIONS: The only differences in postoperative results between groups were stromal neovascularization in DALK group and endothelial rejection in PK group. DALK should be considered as the first option when keratoplasty is indicated in keratoconus

The corneal transplant score: a simple corneal graft candidate calculator.

BACKGROUND: Shortage of corneas for transplantation has created long waiting lists in most countries. Transplant calculators are available for many organs. The purpose of this study is to describe a simple automatic scoring system for keratoplasty recipient candidates, based on several parameters that we consider most relevant for tissue allocation, and to compare the system's accuracy in predicting decisions made by a cornea specialist. METHODS: Twenty pairs of candidate data were randomly created on an electronic spreadsheet. A single priority score was computed from the data of each candidate. A cornea surgeon and the automated system then decided independently which candidate in each pair should have surgery if only a single cornea was available. RESULTS: The scoring system can calculate values between 0 (lowest priority) and 18 (highest priority) for each candidate. Average score value in our randomly created cohort was 6.35 ± 2.38 (mean ± SD), range 1.28 to 10.76. Average score difference between the candidates in each pair was 3.12 ± 2.10, range 0.08 to 8.45. The manual scoring process, although theoretical, was mentally and emotionally demanding for the surgeon. Agreement was achieved between the human decision and the calculated value in 19 of 20 pairs. Disagreement was reached in the pair with the lowest score difference (0.08). CONCLUSIONS: With worldwide donor cornea shortage, waiting for transplantation can be long. Manual sorting of priority for transplantation in a long waiting list is difficult, time-consuming and prone to error. The suggested system may help achieve a justified distribution of available tissue.

Trends in the distribution of donor corneal tissue and indications for corneal transplantation: the New Zealand National Eye Bank Study 2000-2009.

BACKGROUND: To investigate the indications for corneal transplantation and the distribution of donor corneal tissue in New Zealand. DESIGN: Analysis of the prospective database of the New Zealand National Eye Bank. PARTICIPANTS: A total of 2205 corneal transplants were assessed. METHODS: New Zealand National Eye Bank records were analysed for the decade 2000-2009. MAIN OUTCOME MEASURES: Variables analysed included donor corneal tissue distribution (including public and private sectors), indications for transplantation, donor corneal tissue recipient demographics (age and gender) and corneal transplantation type. RESULTS: An average of 220 corneal transplants were performed each year over the 10-year period (n=2205). The median recipient age was 45years (range 3 to 102years) and 54.0% of recipients were male. In total 71.8% of transplants were performed in the public health sector. Surgeons in the Auckland metropolitan area performed 47.2% of all corneal transplants. The most common indications for corneal transplantation were: keratoconus (41.1%), repeat transplant (17.0%), aphakic/pseudophakic bullous keratopathy (13.9%), corneal dystrophy (10.7%), keratitis (7.9%) and trauma (3.7%). Overall, penetrating keratoplasty accounted for 90.7% of all corneal transplants, however, during the latter half of the study there was a progressive shift in transplantation type, with deep anterior lamellar keratoplasty and Descemet's stripping endothelial keratoplasty combined accounting for 32.3% of all transplants in the final year of the study period. CONCLUSIONS: This New Zealand National Eye Bank study provides valuable data regarding the indications for corneal transplantation, transplant recipient demographics and changes in transplantation type in New Zealand over the past decade.

[Keratoplasty -- a simple classification/terminology of current treatment options]. / Keratoplastik -- Eine vereinfachte Klassifikation/Terminologie zur Erfassung aktueller Operationskonzepte.

Thanks to technical advances the surgical options for corneal grafting have been widely expanded in recent years. Promoted by new instruments and techniques for intrastromal dissection a number of variations of lamellar keratoplasty, including descriptive terms and abbreviations have been suggested. This creative chaos, however, lacks simplicity, specificity and structure. Following a short definition of the basic terms we here present a simplified and clearly structured classification, which also incorporates the Anglo-American terminology and should, therefore, be acceptable for the wider international ophthalmic community.

Transplante corneal: análisis retrospectivo de una serie nacional / Corneal transplant: retrospective analysis of a national series

Introducción: Para complementar trabajos realizados previamente decidimos hacer un estudio epidemiológico retrospectivo de los transplantes de córnea realizados en el Servicio de Oftalmología del Hospital del Salvador entre octubre 1997 y enero 2002. Material y método: Se seleccionan aleatoriamente fichas de pacientes sometidos a transplante corneal. Se eliminan de estudio fichas con datos incompletos. Se analizan diversos factores de interés clínico. Resultados: Octubre 1997- Enero 2002: 155 transplantes de córneas. Total de cirugías incluidas en estudio: 102. Cada cirugía es un caso. Son 95 ojos. Algunos ojos operados más de una vez. 4 pacientes con cirugía bilateral (los dos ojos). Promedio de seguimiento de 16,3 meses. Causa más frecuente de transplante de córnea: infecciosa (25,5 por ciento). y dentro de ella: herpética. La sigue la queratopatía bulosa seudofáquica (15.7 por ciento de los casos se usa córnea recién procurada de donantes en muerte cerebral. Las complicaciones postoperatorias más frecuentes fueron epiteliopatías (9,8 por ciento) y falla secundaria (9,8 por ciento). La trasparencia postoperatoria fue buena en un 66,3 por ciento. En 9 casos se evidenció rechazo endotelial, con recuperación de 6 casos. Discusión: La causa infecciosa y, específicamente la herpética, sigue siendo la más frecuente del transplante de córnea, pero disminuyó porcentualmente en relación a series nacionales previas. Aumenta la causa por querotopatía bulosa pseudofáquica. En general se produce un aumento de la agudeza visual cuando objetivo del transplante es óptico, siempre y cuando no haya otra patología que afecte la visión.

Indicaçöes de transplante penetrante de córnea: 1991-1995 / Indications for penetrating keratoplasty: 1991-1995

Foram analisados retrospectivamente prontuários de pacientes submetidos a transplante penetrante de córnea no Departamento de Oftalmologia do Hospital da Santa Casa de Säo Paulo, no período de janeiro de 1991 a dezembro de 1995, com o objetivo de determinar as principais indicaçöes. Duzentos e quarenta e nove transplantes de córnea foram realizados neste intervalo de 5 anos. Idade média foi de 42,6 anos (variou de 1 a 89 anos). Dezenove foram realizados em crianças com idade inferior ou igual a 12 anos. Os casos foram distribuídos em 16 categorias diagnósticas, de acordo com a nomenclatura proposta por Lindquist. Indicaçäo mais comum foi ceratocone com 21,7 por cento, o que contrasta com estudos recentes que têm apontado ceratopatia bolhosa pseudo-fácica como a principal indicaçäo, com progressiva reduçäo de ceratocone. Ceratopatia bolhosa pseudo-fácica, por sua vez, foi a quinta indicaçäo mais comum em nosso estudo, com apenas 8 por cento dos casos..

Design and methods of The Collaborative Corneal Transplantation Studies. The Collaborative Corneal Transplantation Studies Research Group.

The Collaborative Corneal Transplantation Studies (CCTS) is a set of two multicenter clinical trials designed to investigate the efficacy of donor-recipient human leukocyte antigen matching and crossmatching. High-risk penetrating keratoplasty patients were enrolled through six clinical centers for either the Antigen Matching Study or the Crossmatch Study. All patients were subject to a common set of examinations, treatments, and evaluation procedures. Standard procedures for the identification of high-risk patients, administration of postoperative medications, and recognition and treatment of immunologic allograft reactions were developed and used successfully. These procedures may serve as guidelines for studies in corneal transplantation. Adoption of these methods by other investigators would facilitate evaluation and comparison of results.

Queratoplastia en el Hospital Municipal Rísquez 1986-1988 / Keratoplasty in the Hospital Rísquez 1986-1988

El presente estudio retrospectivo correspondiente a 24 casos , 27 ojos, provenientes de la Sección de Córnea del Servicio de Oftalmología del Hospital Municipal Rísquez, durante los años 1986, 1987 y 1988, a quienes se les practicó Queratoplastia. Se analiza la distribución de la muestra según sexo, edad, patología, tipo e indicación de la queratoplastia y los resultados obtenidos

[Penetrating corneal transplants: experience with 114 grafts]. / Trasplantes corneales penetrantes: experiencia con 114 injertos.

A series of 114 penetrating corneal transplants performed in a public hospital in Santiago de Chile by the first author is reported. The first cause of corneal grafting was herpes simplex keratitis (37%), the second keratoconus (22%). Signs of rejection were observed in 32.5% of the grafts and of these, 32% lost transparency. Graft clarity was good in 74% of the grafts and poor in 17.5%. Poor transparency was due to graft rejection in 65% of the cases. Phakic eyes had good transparency in 81% of cases and aphakic eyes only in 48%. Preoperatively the visual acuity was 0.1 or less in 79% of cases and post-operatively it was better than 0.5 in 50% and better than 0.1 in 82% of the cases. The mean postoperative astigmatism was 4.4 diopters. Results in graft clarity were classified according to preoperative prognosis.

Trasplante de córnea / Cornea transplantation

El dominio de las clasificaciones de indicaciones del trasplante corneal y de la endoscopia endotelial esopecular coadyuvan al éxito de esta operación. En este artículo se exponen las técnicas de las queratoplastias lamelar y perforante, así como características de su posperatorio (AU)