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Corneal Transplantation: Recent Advances and Current Perspectives
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Corneal Transplantation: Recent Advances and Current Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: 15 September 2024 | Viewed by 5515

Special Issue Editors

Dr. Mohit Parekh

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Guest Editor
Schepens Eye Research Institute of Mass Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
Interests: ophthalmology; cornea transplantation; keratoplasty; eye banking
Dr. Vito Romano

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Guest Editor
1. Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, Brescia, Italy
2. Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
Interests: cornea transplantation; keratoconus; endothelial dystrophy; imaging; cataract; refractive surgery; pterygium
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Corneal diseases are one of the leading causes of blindness globally. The standard treatment of care includes corneal transplantation. However, keratoplasties rely majorly on donor tissues, which unfortunately are in limited supply, restricting treatment options. Although the burden on the availability of the donor tissues has been minimized with recent advances in keratoplasty techniques, modern devices, and alternative options such as cultured cell transplantation, the requirement is still high to treat corneal diseases globally. Alternative options in advancing the field of corneal transplantation are underway. Hence, this Special Issue aims to look the future of corneal transplantation, and authors are encouraged to submit articles related to a) advanced corneal transplantation techniques; b) inclusion of artificial intelligence for diagnosis and outcome predictions; c) cultured cells or tissue engineering; d) artificial cornea; e) modern day devices; f) robotics in eye surgery; g) modern eye banking; f) imaging; and g) healthcare economics in keratoplasty.

Dr. Mohit Parekh
Dr. Vito Romano
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cornea transplantation
  • keratoconus
  • endothelial dystrophy
  • imaging
  • cataract
  • refractive surgery
  • artificial intelligence
  • devices
  • research
  • tissue engineering

Published Papers (7 papers)

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Research

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10 pages, 5108 KiB  
Article
Donor Characteristics in Graft Detachment after Posterior Lamellar Keratoplasty for Fuchs Endothelial Dystrophy and Bullous Keratopathy
by Nicola Cardascia, Flavio Cassano, Valentina Pastore, Maria Gabriella La Tegola, Alessandra Sborgia, Francesco Boscia and Giovanni Alessio
J. Clin. Med. 2024, 13(6), 1593; https://doi.org/10.3390/jcm13061593 - 11 Mar 2024
Viewed by 513
Abstract
Background: Descemet Membrane Endothelial Keratoplasty (DMEK) has been widely adopted to treat Fuchs endothelial dystrophy (FED) and Bullous keratopathy (BK). Graft detachment (GD) is one of the common earliest post-operatory complications, and it is usually recovered by Air Rebubbling (ARB). Methods: Retrospectively, we [...] Read more.
Background: Descemet Membrane Endothelial Keratoplasty (DMEK) has been widely adopted to treat Fuchs endothelial dystrophy (FED) and Bullous keratopathy (BK). Graft detachment (GD) is one of the common earliest post-operatory complications, and it is usually recovered by Air Rebubbling (ARB). Methods: Retrospectively, we investigated predictive factors related to GD between January 2016 and March 2020, a pre-COVID era, in 72 patients, 72 eyes, and their donors’ lamellar characteristics, focusing on donor’s cause of death. The patients were divided according to the posterior lamellar keratoplasty technique adopted. Results: GD and consequent ARB were most common but not significantly prevalent in DMEK (p = 0.11). It was more common in FED for both surgical approaches. Only in BK treated with DSAEK were host steeper mean astigmatism (p = 0.03) and donors with smaller graft pre-cut diameters (p = 0.02) less likely to be related to GD. Regarding donor’s cause of death, only cardiovascular accident could be related to GD in BK treated with DMEK (p = 0.04). Conclusions: Our study shows that the conventional match between pathology and corneal lenticule is not sufficient to prevent ARB. Donor’s cause of death can impair graft and host attachment. In particular, cardiovascular death may impair the efficiency of donors’ endothelial cells, inducing GD after DMEK in BK. Full article
(This article belongs to the Special Issue Corneal Transplantation: Recent Advances and Current Perspectives)
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12 pages, 1734 KiB  
Article
Predicting Long-Term Endothelial Cell Loss after Preloaded Descemet Membrane Endothelial Keratoplasty in Fuchs’ Endothelial Corneal Dystrophy: A Mathematical Model
by Pietro Viola, Enrico Neri, Tommaso Occhipinti, Mohit Parekh, Roberto Cian, Diego Ponzin, Antonio Moramarco and Alfonso Iovieno
J. Clin. Med. 2024, 13(3), 877; https://doi.org/10.3390/jcm13030877 - 02 Feb 2024
Viewed by 624
Abstract
(1) Background: This study offers a biexponential model to estimate corneal endothelial cell decay (ECD) following preloaded “endothelium-in” Descemet membrane endothelial keratoplasty (DMEK) in Fuchs’ endothelial corneal dystrophy (FECD) patients; (2) Methods: A total of 65 eyes undergoing DMEK alone or [...] Read more.
(1) Background: This study offers a biexponential model to estimate corneal endothelial cell decay (ECD) following preloaded “endothelium-in” Descemet membrane endothelial keratoplasty (DMEK) in Fuchs’ endothelial corneal dystrophy (FECD) patients; (2) Methods: A total of 65 eyes undergoing DMEK alone or combined with cataract surgery were evaluated. The follow-up period was divided into an early phase (first 6 months) and a late phase (up to 36 months). Endothelial cell count (ECC) and endothelial cell loss (ECL) were analyzed; (3) Results: The half time of the ECD was 3.03 months for the early phase and 131.50 months for the late phase. The predicted time-lapse interval to reach 500 cells/mm2 was 218 months (18.17 years), while the time-lapse interval to reach 250 cells/mm2 was 349 months (29.08 years). There was no statistically significant difference between the ECL in DMEK combined with cataract extraction and DMEK alone at 24 months (p ≥ 0.20). At the late phase, long-term ECL prediction revealed a lower ECC half time in patients undergoing DMEK combined with cataract surgery (98.05 months) than DMEK alone (250.32 months); (4) Conclusions: Based on the mathematical modeling, a predicted average half-life of a DMEK graft could reach 18 years in FECD. Moreover, combining cataract extraction with DMEK could result in excessive ECL in the long term. Full article
(This article belongs to the Special Issue Corneal Transplantation: Recent Advances and Current Perspectives)
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14 pages, 1994 KiB  
Article
Ocular Manifestations in Patients Affected by p63-Associated Disorders: Ectrodactyly-Ectodermal Dysplasia-Clefting (EEC) and Ankyloblepharon-Ectodermal Defects-Cleft Lip Palate (AEC) Syndromes
by Enzo Di Iorio, Filippo Bonelli, Raluca Bievel-Radulescu, Nicolò Decastello, Stefano Ferrari, Vanessa Barbaro and Diego Ponzin
J. Clin. Med. 2023, 12(23), 7377; https://doi.org/10.3390/jcm12237377 - 28 Nov 2023
Viewed by 735
Abstract
Background/Aims: The Ectrodactyly-Ectodermal dysplasia-Clefting (EEC) and Ankyloblepharon–ectodermal defect–cleft lip/palate (AEC) syndromes are rare autosomal dominant diseases caused by heterozygous mutations in the p63 gene. Patients are characterized by abnormalities of the skin, teeth, and hair and have limb defects, orofacial clefting and ectodermal [...] Read more.
Background/Aims: The Ectrodactyly-Ectodermal dysplasia-Clefting (EEC) and Ankyloblepharon–ectodermal defect–cleft lip/palate (AEC) syndromes are rare autosomal dominant diseases caused by heterozygous mutations in the p63 gene. Patients are characterized by abnormalities of the skin, teeth, and hair and have limb defects, orofacial clefting and ectodermal dysplasia. In addition, they often show ocular surface alterations, leading to progressive corneal clouding and eventually blindness. Here, we present 8 cases describing patients affected by EEC (n = 6, with 5 sporadic and 1 familial cases) and AEC (n = 2, both sporadic cases) syndromes. We attempt to provide a description of the ocular disease progression over the years. Methods: Clinical examinations and monitoring of ocular parameters for the assessment of limbal stem cell deficiency were constantly performed on patients between 2009 and 2023. Quantitative data and comparison with existing cases described in the literature are reported. Results: The therapies supplied to patients were essential for the management of the symptoms, but unfortunately did not halt the progression of the pathology. Conclusions: A constant monitoring of the patients would help avoid the sudden worsening of symptoms. If the progression of the disease slows down, it would allow for the development of newer therapeutic strategies aimed at correcting the genetic defect. Full article
(This article belongs to the Special Issue Corneal Transplantation: Recent Advances and Current Perspectives)
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10 pages, 616 KiB  
Article
Hemi-Ultrathin Descemet Stripping Automated Endothelial Keratoplasty (Hemi-UT-DSAEK) Using Pediatric Donor Corneas: A Case Series
by Pia Leon, Lorena Francescutti, Pietro Gentile, Federica Birattari, Diego Ponzin, Davide Camposampiero, Antonella Franch and Mohit Parekh
J. Clin. Med. 2023, 12(17), 5442; https://doi.org/10.3390/jcm12175442 - 22 Aug 2023
Viewed by 585
Abstract
Objective: We sought to evaluate the clinical outcomes of hemi-UT-DSAEK grafts from the pediatric donor corneas of patients affected by Fuchs Endothelial Corneal Dystrophy (FECD). Methods: A prospective, interventional case series was conducted at the Ophthalmology Department of Venice Civil Hospital and the [...] Read more.
Objective: We sought to evaluate the clinical outcomes of hemi-UT-DSAEK grafts from the pediatric donor corneas of patients affected by Fuchs Endothelial Corneal Dystrophy (FECD). Methods: A prospective, interventional case series was conducted at the Ophthalmology Department of Venice Civil Hospital and the Veneto Eye Bank Foundation (Venice, Italy). Six eyes of six patients affected by FECD received large-diameter, semicircular hemi-UT-DSAEK grafts obtained from three pediatric donor corneas using the standard pull-through method. Endothelial cell density (ECD), central corneal thickness (CCT), best-corrected visual acuity (BCVA) and intraoperative and postoperative complications were recorded at different time intervals up to 12 months. Results: The average donor age was 64.6 ± 8.6 years, and the pre-operative ECD was 3266 ± 225 cells/mm2. At 12 months postoperatively, the average ECD was 1376 ± 509 cells/mm2 with a mean decrease of 56.8 ± 19.1% from the preoperative donor count. At 12 months, four out of six eyes had significantly improved and reached a BCVA of ≥20/25 (Snellen equivalent). The mean CCT significantly decreased from 788 ± 138 μm before surgery to 576 ± 30 μm at 12 months postoperatively (p < 0.01). Conclusions: Hemi-UT-DSAEK grafts using pediatric donor corneas are surgically feasible and can provide similar clinical outcomes compared to conventional UT-DSAEK. Transplanting pediatric donor tissues with high ECD into two patients could potentially increase the donor tissue pool to treat endothelial disease. Full article
(This article belongs to the Special Issue Corneal Transplantation: Recent Advances and Current Perspectives)
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12 pages, 1248 KiB  
Article
Descemet Membrane Endothelial Keratoplasty (DMEK) Reduces the Corneal Epithelial Thickness in Fuchs’ Patients
by Jens Julian Storp, Larissa Lahme, Sami Al-Nawaiseh, Nicole Eter and Maged Alnawaiseh
J. Clin. Med. 2023, 12(10), 3573; https://doi.org/10.3390/jcm12103573 - 20 May 2023
Viewed by 1001
Abstract
Fuchs’ endothelial corneal dystrophy (FECD) is the occurrence of corneal edema due to endothelial cell dystrophy. Descemet membrane endothelial keratoplasty (DMEK) is considered to be the gold standard of treatment. The aim of this study was to investigate the changes in the corneal [...] Read more.
Fuchs’ endothelial corneal dystrophy (FECD) is the occurrence of corneal edema due to endothelial cell dystrophy. Descemet membrane endothelial keratoplasty (DMEK) is considered to be the gold standard of treatment. The aim of this study was to investigate the changes in the corneal epithelial thickness of FECD patients before and after DMEK and to compare these results with a healthy control cohort. In this retrospective analysis, 38 eyes of patients with FECD that were treated with DMEK and 35 healthy control eyes received anterior segment optical coherence tomography (OCT; Optovue, XR-Avanti, Fremont, CA, USA). The corneal epithelial thicknesses in different locations were analyzed and compared between the preoperative, postoperative, and control cohorts. The median follow-up time was 9 months. There was a significant degression of the mean epithelial thickness after DMEK in the central, paracentral, and mid-peripheral zones (p < 0.01) of the cornea. The total corneal thickness and stromal thickness decreased significantly as well. No significant differences were observed between the postoperative and control cohorts. In conclusion, the FECD patients had an increased epithelial thickness compared to the healthy controls, which decreased significantly after DMEK and reached thickness levels comparable to those of healthy control eyes. This study emphasized the importance of distinguishing between the corneal layers in anterior segment pathologies and surgical procedures. Moreover, it accentuated the fact that the structural alterations in FECD extend beyond the corneal stroma. Full article
(This article belongs to the Special Issue Corneal Transplantation: Recent Advances and Current Perspectives)
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11 pages, 1231 KiB  
Article
Assessing the Learning Curve for DMEK Using Post-Procedural Clinical Outcomes—Comparison of Four Different Surgeons during Two Different Periods
by Emilia Sophie Stuhlmacher, Shady Suffo, Cristian Munteanu, Berthold Seitz and Loay Daas
J. Clin. Med. 2023, 12(3), 811; https://doi.org/10.3390/jcm12030811 - 19 Jan 2023
Cited by 1 | Viewed by 874
Abstract
Purpose: Evaluating the learning curve of individual surgeons for Descemet Membrane Endothelial Keratoplasty (DMEK) and Triple-DMEK and assessing outcome with experience. Methods: The first 41 and the last 41 surgeries of each of the four surgeons were retrospectively included. Surgery duration and graft [...] Read more.
Purpose: Evaluating the learning curve of individual surgeons for Descemet Membrane Endothelial Keratoplasty (DMEK) and Triple-DMEK and assessing outcome with experience. Methods: The first 41 and the last 41 surgeries of each of the four surgeons were retrospectively included. Surgery duration and graft preparation time were recorded. Corrected distance visual acuity (CDVA, logMAR) and central corneal thickness (CCT, µm) were collected preoperatively after 6 and 12 months, as well as postoperative complications, e.g., re-bubbling or repeat penetrating keratoplasty. Results: Surgical duration for Triple-DMEK and DMEK decreased significantly by 21 min and 14 min between the two periods (p < 0.001; p < 0.001). Graft preparation time decreased significantly from 13.3 ± 5.2 min (95%CI 12.8–14.3) in period 1 to 10.7 ± 4.8 min (95%CI 10.2–11.4) in period 2 (p = 0.002). The postoperative changes in CDVA and CCT over both periods were not significant (p = 0.900; p = 0.263). The re-bubbling rate decreased significantly from 51.2% in period 1 to 26.2% in period 2 (p < 0.001). The repeat penetrating keratoplasty (PKP) was 7.3% in period 1 and 3.7% in period 2 (p = 0.146). Re-DMEK was necessary in 6.1% in period 1 and 4.9% in period 2 (p = 0.535). Several parameters showed significant differences between the surgeons in both periods (surgical duration: period 1: p < 0.001, period 2 p < 0.001; graft preparation: period 1: p < 0.001, period 2 p < 0.001). Conclusion: Significant decrease in surgery duration, graft preparation time, and the re-bubbling rate can be attributed to gained individual experience. Full article
(This article belongs to the Special Issue Corneal Transplantation: Recent Advances and Current Perspectives)
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Review

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11 pages, 4357 KiB  
Review
General Treatment and Ophthalmic Management of Peters’ Anomaly
by Bogumil Wowra, Dariusz Dobrowolski, Mohit Parekh and Edward Wylęgała
J. Clin. Med. 2024, 13(2), 532; https://doi.org/10.3390/jcm13020532 - 17 Jan 2024
Viewed by 652
Abstract
Peters’ anomaly (PA) is a manifestation of complex disorders in the development of the anterior segment of the eye. The most recognizable feature of the disease is a doughnut-shaped central corneal opacity and adhesions between the opacity and underlying iris. Glaucoma is observed [...] Read more.
Peters’ anomaly (PA) is a manifestation of complex disorders in the development of the anterior segment of the eye. The most recognizable feature of the disease is a doughnut-shaped central corneal opacity and adhesions between the opacity and underlying iris. Glaucoma is observed in 30–70% of patients, with up to 50% of the patients showing concomitant vision-threatening disorders. Up to 60% of patients have systemic abnormalities or developmental delays. Being a rare malformation, PA is one of the most common congenital indications for corneal transplantation in infants. Penetrating keratoplasty is used as the primary method of treatment in cases with corneal opacification of a degree that forbids visual development in both eyes. The heterogeneity of co-occurring ophthalmic and systemic malformations in the spectrum of PA determines the wide range of success, defined by various endpoints: graft clarity or visual acuity. Although surgical advancement has made corneal grafting possible in younger children, it has a higher graft failure rate and worse visual prognosis than adult keratoplasty. Optical sector iridectomy, pupil dilation, or cornea rotation can alternatively be performed. Satisfying results of pediatric keratoprosthesis in particular cases of PA have been described. Postoperative treatment of PA aims to maintain a clear optical pathway and prevent amblyopia. This article therefore aims at reporting the ophthalmic treatment and need for multidisciplinary management of PA, including pharmacological and surgical treatment. Full article
(This article belongs to the Special Issue Corneal Transplantation: Recent Advances and Current Perspectives)
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