chondroitin-sulfates and Keratoconus

Prospective randomized clinical trial to evaluate the efficacy of lyophilized corneas for deep anterior lamellar keratoplasty (DALK) in patients with keratoconus.. Ten eyes underwent DALK and received corneas that had been lyophilized, and 10 eyes received corneas kept in Optisol. Follow-up examinations included measurement of visual acuity (VA; Early Treatment Diabetic Retiropathy Study chart), topography, pachymetry, specular microscopy, contrast sensitivity, and confocal microscopy.. All variables improved similarly in both groups, without statistical differences between them, except for the uncorrected VA in the sixth postoperative month, which was better in the lyophilized group (0.46) compared with the Optisol group (0.70). The best spectacle-corrected VA was 0.16 in the lyophilized group and 0.26 in the Optisol group. The mean endothelial cell count during the sixth postoperative month was 2778.5 in the lyophilized group and 2611.5 in the Optisol group. Optisol corneas had greater keratocyte density, and the keratocyte density improved in lyophilized corneas during follow-up.. Lyophilized corneas can be used successfully for DALK to treat keratoconus with results similar to Optisol corneas.

Topics: Adult; Chondroitin Sulfates; Complex Mixtures; Cornea; Corneal Topography; Corneal Transplantation; Culture Media, Serum-Free; Dextrans; Eyeglasses; Follow-Up Studies; Freeze Drying; Gentamicins; Humans; Keratitis; Keratoconus; Microscopy, Confocal; Patient Satisfaction; Treatment Outcome; Visual Acuity; Young Adult

To demonstrate the effectiveness and safety of using viscoadaptive viscoelastics in deep lamellar keratoplasty (DLKP) for keratoconus.. A nonrandomized, comparative, interventional case series was performed on 12 eyes of 10 consecutive keratoconus patients without a history of acute hydrops. Patients were treated with DLKP using ophthalmic viscosurgical devices (OVDs) to dissociate Descemet membrane (DM) from the stroma before suturing of the donor cornea. Eight eyes were operated using Viscoat (dispersive), and 4 eyes were operated using Healon V (viscoadaptive).. Six out of 8 eyes in the Viscoat group were successfully treated, and 2 eyes were converted to PKP because of tears in the DM. Another 3 eyes had double chambers as a result of perforations or tears in DM, which were treated by injecting air into the anterior chamber. All 4 eyes in the Healon V group were successfully operated, with 1 case with microperforation of DM during suturing. Healon V offered better control of the area to be dissociated and served as a pseudostroma that protects the exposed DM while the overlying stroma is maneuvered.. Healon V is a valuable tool for performing DLKP in difficult cases such as keratoconus.

Topics: Adult; Chondroitin; Chondroitin Sulfates; Corneal Stroma; Corneal Transplantation; Descemet Membrane; Drug Combinations; Female; Humans; Hyaluronic Acid; Keratoconus; Male; Middle Aged; Safety

To evaluate the outcome of corneal transplants performed with donor corneas that had been stored for prolonged (>168 hours) periods of time in Optisol-GS storage media.. A retrospective review was performed of the medical records of every patient who underwent corneal transplantation between January 1, 1999 and December 31, 1999 utilizing donor tissue that had been in Optisol-GS storage medium for more than 168 hours.. Two hundred thirty-four corneal transplants met the inclusion criteria. The mean duration of follow-up was 33.7 +/- 14.7 months (range 2 to 56 months). The mean Optisol-GS storage time was 237.1 +/- 41.6 hours (range 168 to 348 hours). The overall graft survival rate was 78.6%, ranging from a high of 100% for keratoconus to a low of 42.9% for therapeutic grafts. The likelihood of graft survival, of achieving a visual outcome of 20/40 or better, or of suffering a visual outcome of 20/200 or worse, was not statistically significantly affected by progressively longer periods of donor storage time for the entire study population or for any recipient diagnosis. There were no cases of primary graft failure or early (<3 months) microbial keratitis. An epithelial defect was present on the first postoperative day in every eye. Increased donor storage time was associated with a statistically significant increased risk of persistence of the postoperative epithelial defect for more than 7 days (P = 0.01) as well as for more than 14 days (P = 0.008), although the presence of a postoperative persistent epithelial defect did not have a statistically significant adverse impact on graft survival or visual outcome.. Satisfactory surgical outcomes can be achieved utilizing donor corneas that have been stored in Optisol-GS media for more than 7 days. Ophthalmologists utilizing such tissue should be cognizant of the inevitability of postoperative epithelial defects in these cases as well as increased likelihood of development of persistent epithelial defects.

Topics: Cell Count; Chondroitin Sulfates; Complex Mixtures; Corneal Transplantation; Culture Media, Serum-Free; Dextrans; Endothelium, Corneal; Follow-Up Studies; Gentamicins; Graft Survival; Humans; Keratoconus; Organ Preservation; Retrospective Studies; Time Factors; Treatment Outcome; Visual Acuity

Topics: Animals; Autoradiography; Chondroitin Sulfates; Cornea; Culture Techniques; Dermatan Sulfate; Glucosamine; Glycosaminoglycans; Heparitin Sulfate; Keratan Sulfate; Keratitis; Keratoconus; Rabbits; Time Factors