Indications for penetrating keratoplasty and anterior lamellar keratoplasty during 2010-2017.

AIM: To review the indications of penetrating keratoplasty (PK) and anterior lamellar keratoplasty (ALK) at Qingdao Eye Hospital, Shandong Eye Institute, Qingdao, China, from 2010 to 2017. METHODS: The data of all patients undergoing PK or ALK from January 2010 to December 2017 was retrospectively reviewed, with the indications during 2010-2013 and 2014-2017 compared. RESULTS: A total of 1869 eyes were included, among which 1405 eyes (75.2%) had PK and 464 eyes (24.8%) had ALK. The leading indications were suppurative keratitis (36.8%), keratoconus (15.5%), herpes keratitis (13.1%), and regraft (10.5%). In eyes undergoing PK, the top four indications were suppurative keratitis (38.7%), herpes keratitis (15.3%), keratoconus (12.6%), and regraft (12.5%) during 2014-2017, with the proportion of suppurative keratitis and herpes keratitis decreased while regraft and keratoconus increased compared with 2010-2013. In eyes with ALK, suppurative keratitis (30.8%), keratoconus (24.1%), corneal dystrophies and degenerations (10.6%), and corneal dermoid tumor (9.7%) were the top four indications, and there was no significant difference for the proportion of each indication between 2010-2013 and 2014-2017. CONCLUSION: Suppurative keratitis is the most common indication for PK and ALK at Qingdao Eye Hospital during 2010-2017, followed by keratoconus, herpes keratitis, and regraft. In eyes treated with PK, the proportion of suppurative keratitis and herpes keratitis decrease while regraft and keratoconus increase during 2014-2017 compared with 2010-2013.

Etiology and failure analysis of anterior lamellar keratoplasty.

AIM: To analyze indications and reasons for failure of anterior lamellar keratoplasty (ALK). METHODS: The clinical records were retrospectively reviewed. Main outcome measures included indications for ALK and reasons for failure of ALK. RESULTS: A total of 434 patients (462 eyes) were treated with ALK at Qingdao Eye Hospital, Shandong Eye Institute from June 1, 2009 to May 31, 2016. The main indications were infectious keratitis (33.3%), keratoconus (23.6%), corneal dystrophy and degeneration (9.8%), Mooren's ulcer (8.4%), corneal neoplasm (7.8%), viral keratitis (6.5%) and regrafting (3.7%). Fungal keratitis accounted for 73.4% in the infectious keratitis cases. ALKs were failed in 36 patients, with the major causes being recurrence of primary diseases (63.9%). The leading causes of graft failure was Mooren's ulcer (36.1%), followed by infectious keratitis (30.6%). Recurrence of fungal keratitis accounted for 81.8% in the failed cases after ALK for infectious keratitis cases. CONCLUSION: Infectious keratitis and keratoconus are the main indications for ALK, of which fungal keratitis was the major cause of corneal infections. Recurrence of primary disease is the main reason of graft failure after ALK, in which the main primary diseases associated with graft failure are Mooren's ulcer and fungal keratitis.

A comparative study of risk factors for corneal infection in diabetic and non-diabetic patients.

AIM: To compare the clinical characteristics of infectious keratopathy in type 2 diabetes mellitus (T2DM) and non-diabetes mellitus (NDM) and to investigate risk factors for infectious keratopathy in T2DM patients. METHODS: Totally 230 patients with T2DM and 168 with NDM diagnosed as infectious keratopathy were hospitalized at Qingdao Eye Hospital from 2001 to 2015. Data including sex, age, occupation, season, smoking and alcohol consumption habits, duration between onset and treatments, duration of hospitalization were collected. Initially identified indicators were analyzed with a multivariate logistic regression. Glycosylated hemoglobin A1c (HbA1c) in patients with T2DM was analyzed. The infectious keratopathies in the two groups were categorized and compared. RESULTS: The diabetic group consisted of 146 (63.5%) males and 84 (36.5%) females. The NDM group consisted of 111 (66.1%) males and 57 (33.9%) females. There was no signigicantly difference in sex distribution between the two groups (P>0.05). There were significant differences in age, occupation of patients, season of the onset of diseases, duration between onset and treatment, and durations of hospitalization between the two groups (P<0.05). In most of the patients in the diabetic group, the duration between onset and treatment was ≤3mo, and most was ≥3mo in the NDM group. Multivariate logistic regression analysis revealed that age and season were related to the development of corneal infection in the T2DM group (OR=1.709, 1.706). In the T2DM group, HbA1c was 9.09%±2.12%. There were statistically significant differences in the incidences of bacterial keratitis and herpes simplex keratitis in the two groups (P<0.05), but no significant statistical difference was found between fungal keratitis and amoebic keratitis (P>0.05). CONCLUSION: Advanced age and the summer and winter seasons are identified as risk factors for infectious keratopathy in T2DM patients, and T2DM patients are more prone to bacterial keratitis.

[The roles of gelatinases in pathological changes of fungal keratitis in experimental rabbits].

OBJECTIVE: To study the roles of gelatinases, including matrix metalloproteinase (MMP)-2 and MMP-9, in pathological changes of fungal keratitis in rabbits. METHODS: Eighty New Zealand albino rabbits were randomly and equally divided into 4 groups, 3 of them were test groups, with Fusarium solani, Aspergillus fumigatus, and Candida albicans inoculated onto the right corneas, respectively. In the other group, sterile saline was injected onto the right corneas and was used as the control group. The source and activity of gelatinases were examined by immunohistochemistry and gelatin zymography, respectively. Hematoxylin-eosin stains was applied for observing infiltration of inflammatory cells and degradation of corneal extracellular matrixes (ECMs). Periodic acid-Schiff stain was used for studying hyphal growth patterns and the invasive depth in the cornea. RESULTS: MMP-2 was mainly produced by the keratocytes. Active MMP-2 was detected from day 5 after inoculation and increased greatly on day 8. MMP-9 was mostly produced by neutrophils, and active MMP-9 was detected from day 1 and increased to day 3, then decreased gradually. In A. fumigatus and C. albicans keratitis, the corneal ECMs were degraded obviously, the hyphae grew vertically, and the neutrophils were much more than those in F. solani keratitis whose hyphae grew horizontally and ECMs were degraded slightly. On day 8, the hyphae and neutrophils in F. solani and C. albicans keratitis decreased greatly compared with day 3, but did not change significantly in A. fumigatus keratitis. CONCLUSIONS: There is significant difference in gelatinase activities in the rabbits' corneas infected by F. solani, A. fumigatus, and C. albicans. Gelatinases play important roles in the degradation of corneal ECMs. Hyphal growth pattern and invasive depth are depended on the difference of degradations of ECMs and show difference in various fungal keratitis.

[Penetrating keratoplasty for treatment of fungal keratitis with corneal perforation].

OBJECTIVE: To evaluate the outcome of penetrating keratoplasty (PKP) for the treatment of fungal keratitis with corneal perforation. METHODS: 40 patients (40 eyes) with corneal perforation secondary to fungal keratitis underwent PKP at Qingdao Eye Hospital from 1994 to 2003. The follow-up ranged from 6-24 months. The postoperative visual acuity and complications were documented. RESULTS: 39 (97.5%) patients preserved the eyeballs. The visual acuity improved in 38 (95.0%) eyes. Fungal infection recurred in 4 eyes, 3 of which were controlled with antifungal medication and 1 was enucleated because of the uncontrolled endophthalmitis. Graft rejection was observed in 15 (37.5%) eyes, 12 of which were cured with medication and 3 received secondary PKP. 3 (7.5%) eyes had graft ulceration, 2 of which were cured and the other one was regrafted because of severe endothelial cell loss. 5 (12.5%) eyes had secondary glaucoma, and the intraocular pressure was controlled medically and surgically. Complicated cataract occurred in 5 (12.5%) eyes, 3 of which underwent cataract extraction. Most complications were controlled successfully. At last follow-up, 36 (90.0%) grafts were clear. CONCLUSION: PKP is an effective approach for preservation of eyeballs and restoration of visual function in patients eyes with fungal keratitis and corneal perforation.