Massive corneal edema treated with corneal cross-linking.

2012

Laborante A, Buzzonetti L, Longo C.

Source

Ophthalmic Complex Operating Unit, IRCCS-Hospital Casa Sollievo Della Sofferenza, San Giovanni Rotondo (Foggia), Italy. antoniolaborante@virgilio.it

Abstract

INTRODUCTION:

Massive corneal edema disrupts the fine architecture of corneal stroma that guarantees its transparency, causing opacities that seriously impair clear vision and are usually solved by corneal transplant. Corneal cross-linking, a treatment developed to halt keratoconus progression, results in a loss of water and a compaction of corneal stroma. It might therefore be useful to improve the pathologic edematous condition of some corneas, ameliorating visual acuity and allowing more time for a surgical procedure of keratoplasty.

PATIENTS AND METHODS: 

Six patients with visual impairing corneal edemas further to lens phacoemulsification, penetrating keratoplasty, or post-infective neovascularization were treated with corneal cross-linking alone, or in combination with amniotic membrane apposition with or without anti-angiogenic therapy.

RESULTS:

 All patients partly resolved the edematous condition, improving both corneal transparency and visual acuity.

CONCLUSIONS:

 Corneal cross-linking appears to be a useful method to treat massive corneal edemas, so that keratoplasty can be at least delayed, and need not to be an emergency treatment in these cases.

La Clinica Terapeutica

Graft rejection more likely in eyes with corneal edema

Graft rejection more likely in eyes with corneal edema

There was a lower graft rejection rate in eyes with Fuchs’ dystrophy than in eyes with pseudophakic oraphakic corneal edema, a study found.

In addition, female recipients experienced a higher rejection rate than male recipients, while donor age did not play a role in rejection.

 The analysis used data from the prospective Cornea Donor Study to determine the effect of donor and recipient factors on corneal allograft rejection. The study examined 1,090 patients who underwent penetrating keratoplasty, mostly for Fuchs’ dystrophy or pseudophakic corneal edema. Patients were followed postoperatively for up to 5 years.

The 369 eyes with corneal edema were more likely to experience a rejection event than the 676 eyes with Fuchs’ dystrophy  Female patients had a higher likelihood of rejection compared with male patients. The age of the donors, which ranged from 10 years to 75 years, did not correlate with rejection.

The researchers suggested the need for further studies to better understand whether graft rejection is affected by anti-inflammatory postoperative treatment.

Healio

Corneal edema after cataract surgery: predisposing factors and corneal graft outcome.

Corneal edema after cataract surgery: predisposing factors and corneal graft outcome.

Acta Ophthalmol. 2008 Jun 5

Claesson M, Armitage WJ, Stenevi U.
Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden.

Purpose: Pseudophakic bullous keratopathy (PBK) is one of the main indications for corneal transplantation. Graft survival and visual outcome in this group are often poorer than for other indications. The aim of this study was to find risk factors for developing corneal edema after cataract surgery and factors that influence the subsequent survival of the graft and the visual outcome.

Methods: We carried out an observational, retrospective cohort study using data from the Swedish Cornea Transplant Register and patient medical records. A total of 273 patients whose indication for corneal transplantation was corneal oedema after cataract surgery were included in the study. Multiple logistic regression analysis and, where appropriate, univariate analyses were applied.

Results: A total of 43% of the patients developed persistent corneal oedema immediately after cataract surgery, the main risk factors for which were phacoemulsification and pre-existing endothelial disease. Almost a third (32%) of the transplants for PBK failed within 2 years, for which rejection and other postoperative complications increased the risk. Half (50%) the patients had visual acuity less then 0.1 at 2 years after keratoplasty. Comorbidity, increasing duration of the bullous keratopathy and increasing age affected the visual outcome negatively.

Conclusions: Phacoemulsification was a risk factor for immediate persistent corneal oedema after cataract surgery, although it did not increase the overall risk of developing PBK. However, transplants for immediate PBK had a better survival rate than those for later onset PBK. Shorter duration of PBK and intraocular lens exchange at the time of penetrating keratoplasty increased the likelihood of good visual acuity.

PMID: 18537927 [PubMed - as supplied by publisher]