Reinhard / Larkin Cornea and External Eye Disease

Corneal Allotransplantation, Allergic Disease and Trachoma
1. Auflage 2010
ISBN: 978-3-540-85544-6
Verlag: Springer Berlin Heidelberg
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 163 Seiten

Reihe: Essentials in Ophthalmology

The 8 recurring volumes of the "Essentials in Ophthalmology" series cover the most recent developments in one of eight subspecialties in Ophthalmology. With four volumes published per year, each subspecialty is newly visited every 24 months, with a distinct focus on recent developments. By bridging the gap between original research and medical textbooks, the transfer of this developing knowledge into daily practice is greatly enhanced.

Autoren/Hrsg.

Reinhard, Thomas

Larkin, Frank

Inhaltsverzeichnis

1;Foreword;6
2;Preface;7
3;Contents;8
4;Contributors;14
5;Chapter 1;16
5.1;Immune Privilege of Corneal Allografts;16
5.1.1;1.1 History of Corneal Transplantation and Immune Privilege;16
5.1.2;1.2 How Successful Is Corneal Transplantation?;17
5.1.3;1.3 Immune Rejection of Corneal Allografts;18
5.1.3.1;1.3.1 Role of CD4+ T Lymphocytes in Corneal Allograft Rejection;18
5.1.3.2;1.3.2 Role of CD8+ T Lymphocytes in Corneal Allograft Rejection;18
5.1.3.3;1.3.3 Role of Antibodies in Corneal Allograft Rejection;19
5.1.3.4;1.3.4 Role of Macrophages and NK Cells in Corneal Allograft Rejection;19
5.1.3.5;1.3.5 What are the Eff ectors of Corneal Allograft Rejection?;20
5.1.4;1.4 Role of Atopic Diseases in Corneal Allograft Rejection;20
5.1.5;1.5 Immune Privilege of Corneal Allografts Is a Tripartite Phenomenon;20
5.1.5.1;1.5.1 Aff erent Blockade of the Immune Response to Corneal Allografts;21
5.1.5.2;1.5.2 Immune Deviation in the Central Processing Component of the Immune Reflex Arc;23
5.1.5.3;1.5.3 Eff erent Blockade of the Immune Response to Corneal Allografts;24
5.1.6;References;25
6;Chapter 2;28
6.1;Mechanisms of Corneal Allograft Rejection and the Development of New Therapies;28
6.1.1;2.1 Status of Corneal Transplantation;28
6.1.2;2.2 Success Rate of Corneal Transplantation;28
6.1.3;2.3 Maintenance and Erosion of Corneal Privilege;29
6.1.4;2.4 The Corneal Allograft Response;30
6.1.5;2.5 Antigen Uptake in the Eye;30
6.1.6;2.6 Antigen Processing;31
6.1.7;2.7 Antigen Presentation;31
6.1.8;2.8 T Cell Activation, Proliferation, and Clonal Expansion;32
6.1.9;2.9 Eff ector Arm of the Allograft Response;32
6.1.10;2.10 Current Management of Corneal Transplants;32
6.1.11;2.11 Prevention of Allograft Rejection;32
6.1.12;2.12 Stratifi cation of Risk;33
6.1.13;2.13 Protecting Immune Privilege;33
6.1.14;2.14 Minimizing Antigenic Diff erences Between Donor and Recipient;33
6.1.15;2.15 Systemic Immunosuppression;33
6.1.16;2.16 Surgical Techniques and Postoperative Management;33
6.1.17;2.17 Management of Acute Rejection Episodes;34
6.1.18;2.18 New Therapies with Novel Mechanisms;34
6.1.19;2.19 Antibody-based Immunosuppressive Agents in Transplantation;34
6.1.20;2.20 Engineered Antibodies for Eye Disease;34
6.1.21;2.21 Gene Therapy of the Donor Cornea;35
6.1.22;2.22 Vectors for Gene Therapy of the Cornea;35
6.1.23;2.23 Transgenes for Prolonging Corneal Graft Survival;35
6.1.24;2.24 Future Prospects;35
6.1.25;References;37
7;Chapter 3;39
7.1;New Developments in Topical and Systemic Immunomodulation Following Penetrating Keratoplasty;39
7.1.1;3.1 Introduction;39
7.1.2;3.2 Immunology;40
7.1.2.1;3.2.1 Acute Rejection;40
7.1.2.2;3.2.2 Major Histocompatibility Complex (MHC);40
7.1.2.2.1;3.2.2.1 Direct Pathway of Allorecognition;40
7.1.2.2.2;3.2.2.2 Indirect Pathway of Allorecognition;40
7.1.2.2.3;3.2.3 Chronic Rejection;40
7.1.3;3.3 Normal-risk vs. High-risk Transplantation;41
7.1.3.1;3.3.1 Normal-risk Transplantation;41
7.1.3.2;3.3.2 High-risk Transplantation;41
7.1.3.3;3.3.3 Rationale for Systemic Immunosuppression;41
7.1.3.4;3.3.4 Why Is Immunomodulation with Topical Steroids Not Suffi cient to Prevent Immunologic Graft Rejection in High-Risk Patients?;41
7.1.3.5;3.3.5 Rationale for Topical Immunomodulation;41
7.1.4;3.4 Immunosuppressive Agents;42
7.1.4.1;3.4.1 History;42
7.1.4.2;3.4.2 Corticosteroids;42
7.1.4.3;3.4.3 Cyclosporine A;42
7.1.4.3.1;3.4.3.1 CSA in Corneal Transplantation;43
7.1.4.4;3.4.4 Tacrolimus (fk506);43
7.1.4.4.1;3.4.4.1 Tacrolimus in Corneal Transplantation;43
7.1.4.5;3.4.5 Mycophenolate Mofetil (MMF);43
7.1.4.5.1;MMF in Corneal Transplantation;44
7.1.4.6;3.4.6 Rapamycin (Sirolimus);44
7.1.4.7;3.4.7 RAD (Everolimus);44
7.1.4.8;3.4.8 FTY 720;45
7.1.4.9;3.4.9 FK788;45
7.1.5;3.5 Pimecrolimus;45
7.1.5.1;3.5.1 Pimecrolimus in Corneal Transplantation;45
7.1.5.2;3.5.2 Biologic Agents;45
7.1.5.2.1;3.5.2.1 Basiliximab and Daclizumab;45
7.1.6;3.6 Guidelines for Practitioners;46
7.1.6.1;3.6.1 Systemic Immunosuppression with Drugs with Proven Effi cacy in Corneal Transplantation;46
7.1.6.1.1;3.6.1.1 Preoperative Evaluation;46
7.1.6.1.2;3.6.1.2 How to Use Cyclosporine in High-risk Corneal Transplantation;46
7.1.6.1.3;3.6.1.3 How to Use MMF in High-risk CornealTransplantation;46
7.1.6.2;3.6.2 Topical Immunosuppression;47
7.1.7;3.7 Conclusion;47
7.1.8;References;47
8;Chapter 4;51
8.1;Cytokine Analysis of the Aqueous Humor in the Context of Penetrating Keratoplasty;51
8.2;4.1 Immune Privilege of the Anterior Ocular Segment;52
8.2.1;4.1.1 Anterior Chamber-Associated Immune Deviation (ACAID);52
8.2.2;4.1.2 The Th1/Th2 Paradigm;52
8.3;4. 2 Pitfalls in the Determination of Cytokine Levels from Aqueous Humor;52
8.4;4.3 Relevance of Individual Cytokines in Corneal Transplantation;54
8.4.1;4.3.1 Interleukin 1b;54
8.4.1.1;4.3.1.1 General Functions from In Vitro Experiments;54
8.4.1.2;4.3.1.2 Eff ects in Animal Models of Corneal Transplantation;54
8.4.1.3;4.3.1.3 Interleukin 1b Levels in Human Aqueous Humor;54
8.4.2;4.3.2 Interleukin 2;54
8.4.2.1;4.3.2.1 General Functions from In Vitro Experiments;54
8.4.2.2;4.3.2.2 Eff ects in Animal Models of Corneal Transplantation;54
8.4.2.3;4.3.2.3 Interleukin 2 Levels in Human Aqueous Humor;54
8.4.3;4. 3.3 Interleukin 6;55
8.4.3.1;4.3.3.1 General Functions from In Vitro Experiments;55
8.4.3.2;4.3.3.2 Eff ects in Animal Models of Corneal Transplantatoin;55
8.4.3.3;4.3.3.3 Interleukin 6 Levels in Human Aqueous Humor;55
8.4.4;4.3.4 Interleukin 10;55
8.4.4.1;4.3.4.1 General Functions from In Vitro Experiments;55
8.4.4.2;4.3.4.2 Eff ects in Animal Models of Corneal Transplantation;55
8.4.4.3;4.3.4.3 Interleukin10 Levels in Human Aqueous Humor;55
8.4.5;4.3.5 Interferon Gamma (IFN- gamma );56
8.4.5.1;4.3.5.1 General Functions from In Vitro Experiments;56
8.4.5.2;4.3.5.2 Eff ects in Animal Models of Corneal Transplantation;56
8.4.5.3;4.3.5.3 INF- gamma Levels in Human Aqueous Humor;56
8.4.6;4.3.6 Tumor Necrosis Factor Alpha (TNF- alpha );56
8.4.6.1;4.3.6.1 General Functions from In Vitro Experiments;56
8.4.6.2;4.3.6.2 Eff ects in Animal Models of Corneal Transplantation;56
8.4.6.3;4.3.6.3 TNF- a Levels in Human Aqueous Humor;56
8.4.7;4.3.7 Transforming Growth Factor Beta (TGF- beta);57
8.4.7.1;4.3.7.1 General Functions from In Vitro Experiment;57
8.4.7.2;4.3.7.2 Eff ects in Animal Models of Corneal Transplantation;58
8.4.7.3;4.3.7.3 TGF- b 2 Levels in Human Aqueous Humor;58
8.4.8;4.3.8 Fas, Fas Ligand and Soluble Fas Ligand;58
8.4.8.1;4.3.8.1 General Functions from In Vitro Experiments;58
8.4.8.2;4.3.8.2 Eff ects in Animal Models of Corneal Transplantation;59
8.4.8.3;4.3.8.3 sFasL Levels in Human Aqueous Humor;59
8.4.9;4.3.9 Further Cytokines and Immunomodulative Factors;59
8.4.9.1;4.3.9.1 Interleukin 1 Receptor Antagonist;59
8.4.9.2;4. 3.9.2 Interleukin 4;60
8.4.9.3;4.3.9.3 Interleukin 5;60
8.4.9.4;4.3.9.4 Interleukin 8;60
8.4.9.5;4.3.9.5 Interleukin 12;60
8.4.9.6;4. 3.9.6 Alpha-Melanocyte-Stimulating Hormone/ Calcitonin Gene-Realted Peptide/ Thrombospondin/Somatostatin;60
8.5;4. 4 Cytokine Profi les in the Context of Corneal Transplantation;63
8.5.1;4.4.1 Cytokine Profi les in Animal Models;63
8.5.2;4.4.2 Cytokine Profi les in Humans;63
8.5.2.1;4.4.2.1 Cytokines in the Serum of Patients Following PK;63
8.5.2.2;4.4.2.2 Cytokines in Human Corneas;63
8.5.2.3;4. 4.2.3 Cytokines in Human Aqueous Humor;63
8.6;References;64
9;Chapter 5;67
9.1;Limbal Stem Cell Transplantation: Surgical Techniques and Results;67
9.1.1;5.1 Introduction;67
9.1.1.1;5.1.1 The Corneal Epithelium;67
9.1.1.2;5.1.2 The Limbus and Corneal Epithelial Homeostasis;67
9.1.2;5.2 Corneal LESC Defi ciency;69
9.1.2.1;5.2.1 Diagnosis and Classifi cation of Corneal LESC Defi ciency;69
9.1.3;5.3 Management of Patients with Limbal Stem Cell Defi ciency;71
9.1.3.1;5.3.1 Conservative Options;71
9.1.3.2;5.3.2 Surgical Options for Partial Limbal Stem Cell Defi ciency;71
9.1.3.3;5.3.3 Surgical Options for Total Limbal Stem Cell Defi ciency;71
9.1.3.3.1;Correct any dry eye disease and lid abnormality that is contributing to ocular surface failure;71
9.1.3.3.2;Remove the conjunctival epithelium from the cornea and restore a normal stromal environment;71
9.1.3.3.3;Transplant corneal LESCs to reestablish an intact and transparent epithelium;71
9.1.4;5.4 Surgical Techniques for Transplanting Corneal Limbal Stem Cells;72
9.1.4.1;5.4.1 Conjunctival Limbal Autograft (CLAU);72
9.1.4.2;5.4.2 Living-Related Conjunctival Limbal Allograft Transplant (lr-CLAL);72
9.1.4.2.1;5.4.2.1 Clinical Outcomes of CLAU and lr-CLAL;73
9.1.4.3;5.4.3 Keratolimbal Allograft Transplant;73
9.1.4.4;5.4.4 Ex Vivo Expansion and Transplantation of Cultured Limbal Stem Cells;74
9.1.4.5;5.4.5 Regulations Governing the Clinical Use of Ex vivo Cultured Tissue;74
9.1.4.6;5.4.6 Evidence of the Presence of Stem Cells in Ex vivo Cultures and Grafts;75
9.1.4.7;5.4.7 Assessing Outcomes Following LESC Transplantation;75
9.1.4.8;5.4.8 Evidence for Donor Cell Survival Following Ex Vivo Cultured LESC Transplantation;75
9.1.4.9;5.4.9 Role of Tissue Matching in Transplantation of Allogeneic Tissue or Cells;76
9.1.4.10;5.4.10 Alternative Sources of Autologous Stem Cells;76
9.1.4.11;5.4.11 Issues Surrounding Ex Vivo Cultured LESC Transplantation that Require Further Investigation;76
9.1.5;5.5 Conclusion;77
9.1.6;References;77
10;Chapter 6;82
10.1;Cell Cycle Control and Replication in Corneal Endothelium;82
10.1.1;6.1 Relationship of Endothelial Barrier Function to Corneal Transparency;83
10.1.2;6.2 Corneal Endothelial Cell Loss and Repair Mechanisms;84
10.1.2.1;6.2.1 Causes of Cell Loss;84
10.1.2.2;6.2.2 Repair of the Endothelial Monolayer;84
10.1.3;6.3 Are Human Corneal Endothelial Cells Able to Divide?;84
10.1.3.1;6.3.1 Proliferative Status In Vivo;84
10.1.3.2;6.3.2 Evidence that HCEC Retain Proliferative Capacity;84
10.1.4;6.4 The Cell Cycle;85
10.1.4.1;6.4.1 Positive Regulation of the Cell Cycle;85
10.1.4.2;6.4.2 Negative Regulation of G1-Phase of the Cell Cycle;86
10.1.5;6.5 Potential Causes for Inhibition of HCEC Proliferation In Vivo;87
10.1.5.1;6.5.1 Cell–Cell Contacts Inhibit Division;87
10.1.5.2;6.5.2 Endothelium In Vivo Lacks Effective Paracrine or Autocrine Growth Factor Stimulation;88
10.1.5.3;6.5.3 TGF-Beta2 Has a Suppressive Effect on S-phase Entry;88
10.1.6;6.6 Proliferative Capacity of HCEC Differs with Donor Age;89
10.1.6.1;6.6.1 Analysis of pRb Hyperphosphorylation;90
10.1.6.2;6.6.2 Analysis of Replication Competence;90
10.1.6.3;6.6.3 Analysis of CKI Protein Expression;90
10.1.7;6.7 Efforts to Stimulate Corneal Endothelial Proliferation by Interfering with G1-phase Inhibition;91
10.1.7.1;6.7.1 Overcoming G1-phase Inhibition;92
10.1.7.2;6.7.2 Bypassing G1-phase Inhibition;92
10.1.8;6.8 Endothelial Topography Affects the Proliferative Capacity of HCEC;92
10.1.8.1;6.8.1 Differences in Proliferative Capacity;92
10.1.8.2;6.8.2 Differences in Senescence Characteristics;93
10.1.9;6.9 Identification of Mechanisms Responsible for Decreased Proliferative Capacity;93
10.1.9.1;6.9.1 Are Critically Short Telomeres Responsible for Decreased Proliferative Capacity?;94
10.1.9.2;6.9.2 Is Sub-lethal Oxidative DNA Damage Responsible for Decreased Proliferative Capacity?;94
10.1.10;6.10 Future Directions;95
10.1.11;References;96
11;Chapter 7;100
11.1;Current State of the Art of Fitting Gas-Permeable (GP) Contact Lenses;100
11.1.1;7.1 Corneal Topography and Automatic Fitting Programs;100
11.1.2;7.2 Fitting CLs;101
11.1.3;7.3 The Keratoconus;101
11.1.3.1;7.3.1 KC Peculiarities in Conjunction with CL;101
11.1.3.1.1;7.3.1.1 Corneal Sensitivity and Maximum Resilience;101
11.1.3.1.2;7.3.1.2 Corneal Contour-KC Stage-KC Type;102
11.1.3.2;7.3.2 Forms of Correction;102
11.1.3.2.1;7.3.2.1 Soft Lenses;102
11.1.3.2.2;7.3.2.2 GP Contact Lenses;102
11.1.3.2.3;7.3.2.3 Piggyback;102
11.1.3.2.4;7.3.2.4 Hybrid Lenses;102
11.1.3.3;7.3.3 Fitting Techniques;102
11.1.3.3.1;7.3.3.1 The Reshape and Splint Method;102
11.1.3.3.2;7.3.3.2 The Three-Point Touch Method;102
11.1.3.3.3;7.3.3.3 The Apical Clearance Method;103
11.1.3.3.4;7.3.3.4 Scleral Fitting Method;103
11.1.3.4;7.3.4 GP Fitting Following Cross Linking;103
11.1.4;7.4 CL Fitting Following Penetrating Keratoplasty;104
11.1.4.1;7.4.1 Indications for CLs Following PK;104
11.1.4.2;7.4.2 Indications for CLs Following PK in Comparison with Newer Surgical Techniques;104
11.1.4.3;7.4.3 PK Peculiarities in Conjunction with CLs;105
11.1.4.3.1;7.4.3.1 Corneal Sensitivity, Fitting Quality, and Frequent Follow-Ups;105
11.1.4.3.2;7.4.3.2 The Endothelium and Choice of GP Materials;105
11.1.4.3.3;7.4.3.3 Immune Reactions;105
11.1.4.4;7.4.4 When to Fit?;105
11.1.4.5;7.4.5 Fitting Techniques;106
11.1.4.5.1;7.4.5.1 PK with One or Two Sutures;106
11.1.4.5.2;7.4.5.2 CL Fitting Following Suture Removal;106
11.1.5;Abbreviations;107
11.1.6;References;107
12;Chapter 8;110
12.1;Allergic Disease of the Conjunctiva and Cornea;110
12.1.1;8.1 Introduction and Classification;110
12.1.2;8.2 Clinical Forms;111
12.1.2.1;8.2.1 Seasonal and Perennial Allergic Conjunctivitis;111
12.1.2.2;8.2.2 Vernal Keratoconjunctivitis;111
12.1.2.3;8.2.3 Atopic Keratoconjunctivitis;113
12.1.2.4;8.2.4 Giant Papillary Conjunctivitis;114
12.1.2.5;8.2.5 Contact Blepharoconjunctivitis;114
12.1.2.6;8.2.6 Drug-Induced Conjunctivitis or Keratoconjunctivitis;114
12.1.2.7;8.2.7 Urban Eye Allergy Syndrome;115
12.1.3;8.3 Diff erential Diagnosis;116
12.1.4;8.4 Diagnostic Tests in Ocular Allergy;117
12.1.5;8.5 Ocular Immunity and the Allergic Reaction;117
12.1.5.1;8.5.1 Innate Immunity and Ocular Allergy;117
12.1.5.2;8.5.2 The Allergic Process;118
12.1.5.3;8.5.3 Allergic Infl ammation;119
12.1.6;8.6 The Cornea in Allergic Diseases;120
12.1.6.1;8.6.1 Corneal Immunology;120
12.1.6.2;8.6.2 Allergic Infl ammation and Corneal Damage;120
12.1.6.3;8.6.3 Tear Instability and Corneal Involvement;120
12.1.6.4;8.6.4 Corneal Clinical Manifestations in Ocular Allergy;121
12.1.6.5;8.6.5 Confocal Microscopy and Allergic Keratoconjunctivitis;121
12.1.6.6;8.6.6 Keratoconus and Allergic Conjunctivitis;122
12.1.6.7;8.6.7 Keratoglobus;122
12.1.6.8;8.6.8 Allergic Keratoconjunctivitis and Corneal Infection;123
12.1.6.9;8.6.9 Allergy and Corneal Transplant;123
12.1.6.9.1;8.6.9.1 Immunology;123
12.1.6.9.2;8.6.9.2 Clinical Outcomes;124
12.1.7;8.7 Treatment of Ocular Allergy;124
12.1.7.1;8.7.1 Nonpharmacological Management;125
12.1.7.2;8.7.2 Treatment of Allergic Conjunctivitis;125
12.1.7.2.1;8.7.2.1 Topical Ocular Pharmacological Treatment;125
12.1.7.2.2;8.7.2.2 Topical Nonocular Pharmacological Treatment;126
12.1.7.2.3;8.7.2.3 Systemic Pharmacological Treatment;126
12.1.7.2.4;8.7.2.4 Specifi c Immunotherapy;127
12.1.7.3;8.7.3 Treatment of GPC;127
12.1.7.4;8.7.4 Treatment of Vernal Keratoconjunctivitis;127
12.1.7.4.1;8.7.4.1 Corticosteroids;127
12.1.7.4.2;8.7.4.2 Cyclosporine and Other Immunosuppressive Treatments;128
12.1.7.5;8.7.5 Treatment of AKC;128
12.1.7.5.1;8.7.5.1 Cyclosporine and Other Immunosuppressive Treatments;128
12.1.7.6;8.7.6 Surgical Treatment of Keratoconjunctivitis;129
12.1.8;References;129
13;Chapter 9;134
13.1;Trachoma;134
13.1.1;9.1 Introduction;134
13.1.1.1;9.1.1 Overview;134
13.1.1.2;9.1.2 History;134
13.1.2;9.2 Clinical Features;135
13.1.2.1;9.2.1 Symptoms and Signs;135
13.1.2.2;9.2.2 Trachoma Grading Systems;136
13.1.2.3;9.2.3 Diff erential Diagnosis;136
13.1.3;9.3 Chlamydia Trachomatis;136
13.1.4;9.4 Laboratory Diagnosis;137
13.1.5;9.5 Clinical Signs and Infection;138
13.1.6;9.6 Epidemiology;138
13.1.6.1;9.6.1 Prevalence and Distribution;138
13.1.6.2;9.6.2 Age and Gender;139
13.1.6.3;9.6.3 Risk Factors for Active Trachoma and C. Trachomatis Infection;139
13.1.7;9.7 Pathophysiology of Trachoma;140
13.1.7.1;9.7.1 The Stimulus for Infl ammation and Scarring in Trachoma;140
13.1.7.2;9.7.2 Histopathology;141
13.1.7.3;9.7.3 The Immune Response in Trachoma;141
13.1.7.4;9.7.4 Immunopathogenesis of Conjunctival Scarring;142
13.1.8;9.8 Trachoma Control;143
13.1.8.1;9.8.1 The SAFE Strategy;143
13.1.8.2;9.8.2 Surgery for Trichiasis;143
13.1.8.3;9.8.3 Antibiotics;143
13.1.8.4;9.8.4 Face Washing;145
13.1.8.5;9.8.5 Environmental Improvements;145
13.1.9;9.10 Conclusion;145
13.1.10;References;146
14;Chapter 10;149
14.1;Keratoprosthesis;149
14.1.1;10.1 Introduction;149
14.1.2;10.2 Prognostic Hierarchy;150
14.1.3;10.3 Defi ning Patient Subtypes;150
14.1.3.1;10.3.1 Patient Subtype A: The Noninfl amed Eye;150
14.1.3.2;10.3.2 Patient Subtype B: The Infl amed Eye;150
14.1.4;10.4 Experience with Kpro in Patient Subtype A;150
14.1.4.1;10.4.1 Boston Type 1 Kpro;150
14.1.4.1.1;10.4.1.1 Pediatric Application of Boston Type 1 Kpro;151
14.1.4.2;10.4.2 AlphaCor Kpro;152
14.1.5;10.5 Experience with Kpro in Patient Subtype B;152
14.1.5.1;10.5.1 Osteo-Odonto Keratoprosthesis (OOKP);152
14.1.5.2;10.5.2 Boston Type 2 Kpro;153
14.1.6;10.6 Other Kpro Designs;153
14.1.6.1;10.6.1 Pintucci Kpro;153
14.1.6.2;10.6.2 Seoul-Type Kpro;153
14.1.6.3;10.6.3 Worst-Singh Kpro;153
14.1.6.4;10.6.4 Russian/Ukrainian Experience;154
14.1.7;10.7 New Directions in Kpro Research;154
14.1.7.1;10.7.1 Hydroxyapatite Biologic Haptics;154
14.1.7.2;10.7.2 Biologic Coatings;154
14.1.7.3;10.7.3 Biologic Scaff olds and Enhanced Hydrogels;154
14.1.8;10.8 Conclusion;154
14.1.9;References;155
15;Chapter 11;157
15.1;Posterior Lamellar Keratoplasty in Perspective;157
15.1.1;11.1 Introduction;157
15.1.2;11.2 Choosing Endothelial Keratoplasty Procedures;158
15.1.2.1;11.2.1 Indications;158
15.1.2.2;11.2.2 Preoperative Considerations;158
15.1.2.2.1;11.2.2.1 Confi rming the Extent of Endothelial Dysfunction;158
15.1.2.2.2;11.2.2.2 Corneal Scarring;159
15.1.2.2.3;11.2.2.3 Cataract and Intraocular Lens Status;159
15.1.2.2.4;11.2.2.4 Lens/Iris Diaphragm Status;159
15.1.2.2.5;11.2.2.5 Intraocular Pressure;160
15.1.2.2.6;11.2.2.6 Retinal Function;160
15.1.3;11.3 PLK Surgical Technique;160
15.1.3.1;11.3.1 Donor Preparation;160
15.1.3.2;11.3.2 Host Dissection for DSEK/DSAEK;160
15.1.3.3;11.3.3 Donor Insertion;161
15.1.3.4;11.3.4 Techniques for Graft Centration;161
15.1.3.5;11.3.5 Techniques for Promoting Donor Adhesion;162
15.1.3.6;11.3.6 Post-operative Care;163
15.1.3.7;11.3.7 Surgery for Complex Cases;163
15.1.3.7.1;11.3.7.1 Failed Grafts;163
15.1.3.7.2;11.3.7.2 Aniridics, Vitrectomised and Aphakic Eyes;165
15.1.3.7.3;11.3.7.3 Anterior Chamber Lens;165
15.1.4;11.4 Clinical Results and Complications;165
15.1.4.1;11.4.1 Visual Acuity;165
15.1.4.2;11.4.2 Astigmatism;165
15.1.4.3;11.4.3 Spherical Equivalent;165
15.1.4.4;11.4.4 Endothelial Cell Loss;166
15.1.4.5;11.4.5 Corneal Donor Dislocation;167
15.1.4.6;11.4.6 Pupillary Block;168
15.1.4.7;11.4.7 Primary Graft Failure;168
15.1.4.8;11.4.8 Rejection;168
15.1.4.9;11.4.9 Other Complications;168
15.1.5;11.5 Conclusion;169
15.1.6;References;169
16;Index;172