EK (DLEK, DSEK, DMEK): New Frontier in Cornea Surgery.

Endothelial keratoplasty (EK) has revolutionized treatment of corneal endothelial dysfunction. Compared with penetrating keratoplasty (PK), EK provides faster and more reliable visual rehabilitation while maintaining the eye's structural integrity. The number of EK procedures is growing annually and surpassed PK in the United States in 2012. The most widely used iteration, Descemet stripping endothelial keratoplasty (DSEK), implants healthy donor endothelium, Descemet membrane, and posterior stroma. Descemet membrane endothelial keratoplasty (DMEK) eliminates the donor stromal layer. Although more surgically challenging than DSEK, DMEK provides even faster visual rehabilitation and reduced risk of immunologic rejection, so its use is growing. Potential future alternatives to EK that could help address the unmet demand for donor corneas include removing central guttae and regenerating a central endothelial cell layer from healthy peripheral cells in patients with Fuchs' dystrophy or injecting cultured human corneal endothelial cells to rehabilitate eyes without residual healthy endothelium.

[Historic Survey of Posterior Lamellar Keratoplasty Techniques - an Overview]. / Historický prehled technik zadní lamelární keratoplastiky.

Some of the modifications of posterior lamellar keratoplasty is at the present considered by most of the corneal surgeons as method of choice in case of patients corneal endothelium damage. However, this surgical technique undergoes in the last 20 years relatively rapid development. Even in the current time, there exist side by side and are used different types and modifications of this sort of transplantation. Because of this reason, differences among individual methods are sometimes not accurately understood and the terminology may be used not exactly as well. The authors specify all until now described surgical methods, describe differences among single surgical procedures, and point out their advantages and disadvantages. The methods are described in the same order as they were historically introduced into the literature.Key words: posterior lamellar keratoplasty, surgical methods.

Vladimir Petrovich Filatov, uno de los padres del trasplante corneal / Vladimir Petrovich Filatov, one of the fathers of corneal transplant

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History of corneal transplantation in Australia.

Corneal transplantation is a triumph of modern ophthalmology. The possibility of corneal transplantation was first raised in 1797 but a century passed before Zirm achieved the first successful penetrating graft in 1905. Gibson reported the first corneal graft in Australia from Brisbane in 1940 and English established the first eye bank there a few years later. Corneal transplantation evolved steadily over the twentieth century. In the second half of the century, developments in microsurgery, including surgical materials such as monofilament nylon and strong topical steroid drops, accounted for improvements in outcomes. In 2013, approximately 1500 corneal transplants were done in Australia. Eye banking has evolved to cope with the rising demands for donor corneas. Australian corneal surgeons collaborated to establish and support the Australian Corneal Graft Registry in 1985. It follows the outcomes of their surgery and has become an important international resource for surgeons seeking further improvement with the procedure.

Del milagro al sueno cumplido: retorica de la esperanza y reivindicacion profesional en las noticias de prensa sobre trasplantes en Espana, 1900-1960 / From miracle to dream come true: the rhetoric of hope and support for the medical profession in news items on transplants in Spain, 1900-1960

Estudia la construcción de la confianza social en los trasplantes por el análisis histórico-discursivo de fuentes periodísticas entre 1900 y 1960 en España. Manteniendo la ‘retórica de la esperanza’ como estrategia de representación periodística de los trasplantes, el repertorio discursivo inicial fue la imagen médica heroica que los modeló como prácticas milagrosas. Tras la estandarización quirúrgica de los implantes corneales, los trasplantes se conceptualizaron como un sueño cumplido gracias al conocimiento científico y técnico de médicos ‘expertos’. Desde las primeras noticias sobre trasplantes renales, la prensa auspició la ciencia como un futuro mejor pero, reflejando una postura médica más cautelosa y la confianza en la cuantificación de los resultados.

The article studies the building of public trust in transplants via a historico-discursive analysis of media sources from 1900 to 1960 in Spain. Maintaining the ‘rhetoric of hope’ as the journalistic strategy for representing transplants, the initial discursive approach involved the image of the doctor as hero, and transplants as miraculous events. After corneal implants became widespread, transplants were presented as a dream come true thanks to the scientific and technical skills of expert physicians. Since the first news of kidney transplants, the press stressed the promise of a better future through science but reflecting a more cautious medical position and confidence that results could be quantified.

Evolution of keratoplasty: from darkness to light.

The story of the evolution of corneal grafting reads like a modem day epic: Complete with a cast of larger than life heroes, brilliant and heroic feats, inspired by the mundane. The history is also peppered with dismal, heart rending failures, foolhardy ventures, and the ultimate triumph of the indomitable human spirit over all odds. This review aims to highlight the significant milestones in the rich history of corneal transplantation, and to pay tribute to the many inspired and dedicated pioneers in this field for their perseverance and superior wisdom. It is also a salute and memorial to the patients who reposed their trust in the corneal surgeons, subjecting themselves to the trauma of surgery, often with less than optimal results. It was their collective, relentless toil and dynamic vision which has resulted in the state of the art surgical techniques which are the basis of modern day keratoplasty.

Changing indications for lamellar keratoplasty in Shandong, 1993 - 2008.

BACKGROUND: With the advancement of microsurgical techniques, lamellar keratoplasty (LK) has been more valued and performed to treat corneal blindness. This study aimed to evaluate the indications and changing trends for LK during the past 16 years in Shandong Eye Institute, an eye center in China. METHODS: A total of 1529 eyes, predominantly from male (70.7%) patients undergoing LK between January 1993 and December 2008, were enrolled in this study. Data were collected by reviewing patient medical records for demographic characteristics, clinical diagnosis, laboratory findings and risk factors. Surgical times, initial diagnoses and causes of regrafting were recorded. All LKs were sequentially divided into period 1 (from 1993 to 2000) and period 2 (from 2001 to 2008). RESULTS: Rural-dwelling patients in this study numbered 1089 (71.2%); in all cases of infectious keratitis, rural patients accounted for 90.5%. The leading indications for LK were infectious keratitis (31.0%), corneal trauma (21.1%), keratoconus (18.7%), corneal dystrophy and degeneration (7.3%), regrafting (7.1%), immunologic disorders (6.7%), congenital abnormalities and corneal tumor (4.1%) and corneal scarring (3.1%). The most common subcategory of infectious keratitis was fungal keratitis (67.5%). Fusarium solani was the most morbigenous fungi. Among the patients, 73.1% of thermal burns were caused by hot molten metal, and 47.8% of alkali burns by lime. Dermoid was the most common indication for congenital abnormalities. The two main initial diagnoses from 109 regrafting cases were corneal trauma (45.9%) and Mooren's ulcer (27.5%). The most common cause for regrafting was immune rejection (35.8%). Infectious keratitis was the most common indication for LK from 16.0% in period 1 to 41.1% in period 2, followed by keratoconus (16.8%) and corneal trauma (14.5%). CONCLUSIONS: During the past 16 years, there have been major changes in the constituent ratios of leading indications for LK in Shangdong. Infectious keratitis has become the most common indication for LK. Fungal keratitis was the most common subcategory of infectious keratitis.

Endothelial keratoplasty: historical perspectives, current techniques, future directions.

Endothelial keratoplasty (EK) has recently emerged as an alternative to penetrating keratoplasty (PK) for patients with endothelial diseases, including Fuchs' endothelial dystrophy, pseudophakic bullous keratopathy, and corneal graft failure. EK provides distinct advantages over PK, in that it is a less invasive procedure and leads to more rapid recovery of vision. Additionally, this procedure does not require long-term corneal sutures, eliminating problems with suture breakage, suture abscesses, astigmatism, and wound dehiscence. Disadvantages of EK include the need for specially prepared donor tissue and additional surgeon training or experience. In this review we discuss the history of EK, recent advances that have led to its widespread use, limits and complications of the procedure, and areas for future improvement.

[Layer by layer - component surgery in corneal transplantation]. / Schicht für Schicht - Die mabetageschneiderte Keratoplastik.

Penetrating keratoplasty represented the gold standard in corneal transplantation for more than a century. Recent refinements of surgical technique and instrumentation have allowed for a shift towards the transplantation of selected components of the cornea as opposed to full thickness transplantation. Depending on the lamellar technique chosen, the main advantages of lamellar component surgery over penetrating surgery may include a reduced rate of endothelial failure secondary to immunological rejection and faster visual rehabilitation. This brief review discusses the indications for penetrating and lamellar techniques and compares advantages and disadvantages of these treatment modalities.

Keratoplasty in Hungary.

The first keratoplasty was performed in Hungary in 1909, but the transplantations were started in large numbers after the Second World War in Debrecen. Since 1992 a National Keratoplasty Register is functioning at the Department of Ophthalmology Debrecen. The present paper gives an overview on the current status of keratoplasty in Hungary based on the data of this Register. The number of corneal transplantations more than doubled in the past two decades. In the past 3 years (2005 to 2008) the number of transplantation seemed to stabilize around a bit more than 700. The ratio of preserved corneas disclosed a constant increase. The turning point was 1997, few years after the establishment of the Debrecen Eye Bank in 1994, when more preserved corneas were transplanted than fresh ones. The law regulating the procurement and the transplantation of corneas in our country is based on presumed consent and explicit objection which is the better type of regulation for the performance of keratoplasties in large numbers. The number of corneal transplantations in Hungary in the past decades was similar to the figures of industrial countries.