Changing indications and surgical techniques for corneal transplantation between 2004 and 2009 at a tertiary referral center

The aim of this study is to report the indications, techniques, and clinical outcomes of corneal transplantation and investigate any changing trends in surgical techniques over a 6 year period. Records of patients who had undergone any kind of corneal transplantation at Labbafinejad Medical Center, Tehran, Iran, from January 2004 to December 2009 were reviewed to determine the indications and types of corneal transplantation. Postoperative best-corrected visual acuity, refractive error, graft clarity, and complications were reported. During this period, 1859 eyes of 1624 patients with a mean age of 41.3 +/- 21.3 years underwent corneal transplantation. The most common indication was keratoconus [38.4%] followed by aphakic/pseudophakic bullous keratopathy [11.7%], previous failed grafts [10.6%], infectious corneal ulcers [10.1%], non-herpetic corneal scars [7.6%], trachoma keratopathy [4.7%], stromal corneal dystrophies [4.6%], post-herpetic corneal scar [3.7%], Fuchs' endothelial dystrophy [0.8%], and congenital hereditary endothelial dystrophy [0.4%]. Techniques of corneal transplantation included penetrating keratoplasty [PKP; 70.9%], deep anterior lamellar keratoplasty [DALK; 20.1%], conventional lamellar keratoplasty [LKP; 4.4%], and Descemet's stripping automated endothelial keratoplasty [DSAEK; 2.3%]. Over the study period, there was a significant increase in the relative frequency of infectious corneal ulcers, failed grafts, and trachoma keratopathy. Additionally, a significant reduction was observed in PKP and LKP procedures, and volume of DALK and DSAEK increased significantly. At final follow-up, 69.0% of grafts were clear in the PKP group. This figure was 82.6%, 82.7%, and 97.6% in the DALK, LKP, and DSAEK groups, respectively. Keratoconus was the most common indication and PKP was the most prevalent technique used for corneal transplantation. However, significant changes in the indications and surgical techniques were observed from 2004 to 2009

Indications for corneal transplantation at a tertiary referral center in Tehran

To report the indications and techniques of corneal transplantation at a tertiary referral center in Tehran over a 3-year-period. Records of patients who had undergone any kind of corneal transplantation at Labbafinejad Medical Center, Tehran, Iran form March 2004 to March 2007 were reviewed to determine the indications and types of corneal transplantation. During this period, 776 eyes of 756 patients [including 504 male subjects] with mean age of 41.3 +/- 21.3 years underwent corneal transplantation. The most common indication was keratoconus [n=317, 40.8%], followed by bullous keratopathy [n=90, 11.6%], non-herpetic corneal scars [n=62, 8.0%], infectious by corneal ulcers [n=90, 11.6%], non-herpetic corneal scars [n=317, 40.8%] followed by bullous keratopathy [n= 61, 7.9%], previously failed grafts [n=61, 7.9%], endothelial and stromal corneal dystrophies [n=28, 3.6%], and trachoma keratopathy [n=26, 3.3%]. Other indications including Terrien's marginal degeneration, post-LASIK keratectasia, trauma, chemical burns, and peripheral ulcerative keratitis constituted the rest of cases. Techniques of corneal transplantation included penetrating keratoplasty [n=607, 78.2%], deep anterior lamellar keratoplasty [n=108, 13.9%], conventional lamellar keratoplasty [n=44, 5.7%], automated lamellar therapeutic keratoplasty [n= 8, 1.0%], and Descemet stripping endothelial keratoplasty [n=6, 0.8%] in descending order. The remaining cases were endothelial keratoplasty and sclerokeratoplasty. In this study, keratoconus was the most common indication for penetrating keratoplasty which was the most prevalent technique of corneal transplantation. However, deep anterior lamellar keratoplasty is emerging as a growing alternative for corneal pathologies not involving the endothelium

Risk factors for posterior capsule rupture and vitreous loss during phacoemulsification

To determine the rate and risk factors of vitreous loss during phacoemulsi-fication in patients with cataracts operated by ophthalmology residents and fellows at Labbafinejad Medical Center. This prospective descriptive study included consecutive patients with cataracts undergoing phacoemulsification over a one year period. All patients were operated under local or general anesthesia using the divide and conquer technique. Preoperatively, all patients underwent a complete ocular examination including measurement of visual acuity, slitlamp biomicroscopy, intraocular pressure measurement, and dilated funduscopy. Main outcome measures included the rate of posterior capsular rupture and vitreous loss as well as associated risk factors such as surgical experience, ocular and systemic conditions, and type and severity of the cataract. Overall, 767 eyes of 767 patients with mean age of 63.7 +/- 10.3 [range, 25-91] years were operated. The overall rate of vitreous loss was 7.9% which was 5-fold greater in the hands of residents as compared to fellows. Among different factors, older age, female sex, small pupil, small capsulorrhexis, presence of pseudoexfoliation, and high myopia were significantly associated with vitreous loss. The highest rate of vitreous loss occurred in patients with dense nuclear cataracts. Considering the higher rate of vitreous loss in patients operated by ophthalmology residents; patients with known risk factors for vitreous loss should better be operated by more experienced surgeons

Early results of autologous cultivated limbal stem cell transplantation in total limbal stem cell deficiency

To report the early results of transplantation of autologous limbal stem cells cultivated on amniotic membrane [AM] in patients with total unilateral limbal stem cell deficiency [LSCD]. Four eyes of 4 patients with total unilateral LSCD confirmed with impression cytology underwent transplantation of autologous limbal stem cell cultivated on AM. At each follow up visit, a complete eye examination with special attention to recurrence or regression of vascularization, corneal opacification, and epithelial defect healing was performed. Digital imaging was performed at each follow up visit. Impression cytology was repeated in all cases after surgery. The patients were followed for 5-13 months. Visual acuity improved in all cases. Decrease in corneal opacification and vascularization was obvious in 3 cases with coverage of the cornea with corneal epithelium. Sectoral conjunctivalization was evident in these 3 cases, however the corneas were ready for transplantation. The procedure failed in one case with total corneal conjunctivalization. Transplantation of autologous stem cells cultivated on AM seems to be an effective way for total LSCD. More definite judgment needs longer follow up together with long-term results of corneal transplantation in these patients