Potential benefits of modified corneal tissue grafts for keratoconus: Bowman layer ‘inlay’ and ‘onlay’ transplantation, and allogenic tissue ring segments

Purpose of review Keratoconus can be surgically challenging, especially in advanced cases. Classic corneal transplantation techniques, may often be associated with complications. New alternative procedures like isolated Bowman layer transplantation (as a corneal stromal inlay or as a corneal onlay) and corneal allogenic intrastromal ring segments (CAIRS) have recently shown promising results. The aim of this review is to describe the main new surgical developments for treating keratoconus. Recent findings Intrastromal Bowman layer transplantation has recently shown to be effective in halting keratoconus progression and maintaining visual acuity with contact lenses, at least up to 5–7 years postoperatively. Because intrastromal dissection can be challenging, we have recently developed a technique that allows using Bowman layer grafts as an onlay, that is positioned onto the patient's anatomical Bowman layer or anterior stroma, achieving comparable results as with Bowman layer inlay transplantation. CAIRS may also be an effective treatment, improving visual acuity, corneal surface parameters and keratoconus progression. Summary There are currently some new alternative treatments such as isolated Bowman layer inlay or onlay transplantation and CAIRS, both of which seem effective at treating keratoconus and which may offer a less invasive surgical approach.
Source: Current Opinion in Ophthalmology - Category: Opthalmology Tags: CORNEAL AND EXTERNAL DISORDERS: Edited by Shahzad I. Mian Source Type: research

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Anahita Kate, Joveeta Joseph, Bhupesh BaggaIndian Journal of Ophthalmology 2020 68(7):1463-1466 A 21-year-old boy underwent deep anterior lamellar keratoplasty (DALK) for advanced keratoconus. Postoperatively, slit lamp examination revealed multiple foci of interface infiltrates. Medical therapy was non-responsive, and therefore, a repeat lamellar transplantation was done. Scrapings were taken from host stroma and under the surface of the initial graft. Microbiological examination, aided by VITEK-2, revealed the causative organism as Kocuria kristinae. The postoperative course was uneventful and at a 1-year follow-up, the...
Source: Indian Journal of Ophthalmology - Category: Opthalmology Authors: Source Type: research
Conclusion: CXL is a safe and effective method in treating progressive keratoconus. However, the clinical benefits can differ among patients, and in our series, a nonnegligible number of cases show a continued progression of their ectasia. Further studies to identify predictors of postoperative progression prior to the procedure could help sort out good responders to treatment. PMID: 32566268 [PubMed]
Source: Journal of Ophthalmology - Category: Opthalmology Tags: J Ophthalmol Source Type: research
Abstract With the advancement of computational power, refinement of learning algorithms and architectures, and availability of big data, artificial intelligence (AI) technology, particularly with machine learning and deep learning, is paving the way for 'intelligent' healthcare systems. AI-related research in ophthalmology previously focused on the screening and diagnosis of posterior segment diseases, particularly diabetic retinopathy, age-related macular degeneration and glaucoma. There is now emerging evidence demonstrating the application of AI to the diagnosis and management of a variety of anterior segment c...
Source: The British Journal of Ophthalmology - Category: Opthalmology Authors: Tags: Br J Ophthalmol Source Type: research
This article describes the statistical analysis plan for this trial as an update to the published protocol. It is written before the end of the patient follow-up, while the outcome of the trial is still unknown.Design and methodsKERALINK is a randomised controlled, observer-masked, multicentre trial in progressive keratoconus comparing epithelium-off CXL with standard care, including spectacles or contact lenses as necessary for best-corrected acuity. Keratoconus is a disorder of the shape of the cornea in which the normally round dome-shaped clear front window of the eye (cornea) thins progressively leading to a cone-like...
Source: Trials - Category: Research Source Type: clinical trials
Authors: Ali Javadi M, Kanavi MR, Safi S Abstract Purpose: To report the 27-year statistical data from the Central Eye Bank of Iran (CEBI) and its activity. Methods: All CEBI records regarding procured eyes, tissue utilizations, corneal transplants per capita, and indications for keratoplasty from 1991 to 2017 were analyzed. Results: In total, 115,743 whole eyes were donated during the 27-year period. Out of the 114,169 eyes donated between 1994 and 2017, 95,314 eyes were distributed for transplantation, and 95,057 corneas were actually transplanted. The mean annual rate of corneal transplants per capita wa...
Source: Journal of Ophthalmic and Vision Research - Category: Opthalmology Tags: J Ophthalmic Vis Res Source Type: research
Conclusions: There is a need for a comprehensive and high-quality patient-reported outcome measure in keratoconus. A questionnaire should be chosen based on the purpose and the quality of the questionnaire. This review guides selection of an appropriate questionnaire.
Source: Cornea - Category: Opthalmology Tags: Review Source Type: research
AbstractThe aim of this study was to report the 12-year longitudinal trends in regional disparity in terms of indications, techniques and waiting period for corneal transplantation in France from 2004 to 2015. The records of all corneal transplantations performed from 2004 to 2015 in France were retrospectively reviewed by analasing the registry and the territorial organization [divided France into 7 interregional areas of collection and distribution of grafts (IACD)] of the French Biomedicine Agency. A total of 46,658 corneal transplantations were performed between 2004 and 2015. In 2014, there was 65.8 keratoplasties per...
Source: Cell and Tissue Banking - Category: Stem Cells Source Type: research
Conclusions: The use of alternate topical corticosteroids may be considered in cases of steroid-induced ocular hypertension after PKP because they offer good antiinflammatory prophylaxis with reduced hypertensive response.
Source: Cornea - Category: Opthalmology Tags: Clinical Science Source Type: research
Purpose To investigate the success and failure of scleral lens fitting for keratoconus with resolved hydrops.
Source: Contact Lens and Anterior Eye - Category: Opthalmology Authors: Source Type: research
Authors: Ghemame M, Charpentier P, Mouriaux F Abstract Developments in corneal topography allow for increasingly precise, detailed analysis of the corneal surface. This test is becoming indispensable in the treatment of complex corneas: keratoconus, corneal transplants, orthokeratology, etc. In refractive surgery, the combined analysis of the anterior and posterior cornea has permitted better screening for forme fruste keratoconus at risk for post-LASIK ectasia. Topography also assists in the calculation of premium intraocular lenses. Topography is an indispensable test for analyzing and following corneal disease. ...
Source: Journal Francais d Ophtalmologie - Category: Opthalmology Tags: J Fr Ophtalmol Source Type: research
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