CLINICAL RESULTS OF MODIFIED TREATMENT OF KERATOCONUS
About the author:
Kondratenko Y. M., Shargorodska I. V., Lavryk N. S., Lysenko M. G.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
The results of dynamic changes of visual functions (BUVA and BCVA), central corneal graft thickness and endothelial cells density in the corneal grafts were statistically analyzed. Aim: to improve the effectiveness of visual rehabilitation of patients with keratoconus by using morphometric criteria for the quality of donor material at the selection stage and additional protection of endothelium of the corneal transplant at the transplantation stage. Object and methods. All patients with keratoconus were included at three clinical groups and had examinations before surgery and 1, 3, 6, 9, 12 months after the standard subtotal penetrating keratoplasty. Ex vivo confocal microscopy took place in all cadaveric donor eyeballs after corneal graft removing. Dynamic changes of visual functions, corneal thickness and endothelial cells density in the corneal grafts after penetrating keratoplasty in keratoconus cases analyzed in three clinical groups. The first clinical group includes patients who received corneal graft with standard quality criteria of donor cornea. The second clinical group includes patients who received corneal graft with using morphometric criteria of donor cornea quality: coefficient of reflectivity of corneal endothelial cells >50 and absence of visible organelles in the cytoplasm of endothelial cells in confocal microscopy ex vivo. The third clinical group includes patients with keratoconus who received corneal graft with using morphometric criteria of donor cornea quality and supplementary intraoperative endothelioprotection of corneal grafts. The results are showed that after statistical data processing was found that the use of morphometric criteria of donor cornea quality (coefficient of reflectivity of corneal endothelial cells >50; absence of visible organelles in the cytoplasm of endothelial cells) statistically significant increases of visual rehabilitation already in 6 month after penetration keratoplasty. Also using of morphometric criteria of donor cornea quality statistically significant decreases a loosing of endothelial cells density in the corneal graft already in 6 month after penetration keratoplasty, but does not affect the central graft thickness. Supplementary intraoperative endothelioprotection at the “back table” stage does not affect the visual outcomes and central graft thickness, but in the case of combination with using morphometric criteria of donor cornea quality it statistically significant increases of visual rehabilitation already in 3 month after penetration keratoplasty. Morphometric criteria (refractive index of endothelial corneal cells and the presence of organelles in the cytoplasm of the endothelial cells) are a very effective criterion for the quality of the cornea donor. The size of the CRPCR may depend on processes in the endothelial cell cytoplasm and be a quantitative marker for endothelial cell apoptosis. This property of the cornea requires further study and can serve as an informative supra-positive reaction in forensic medicine and anatomy.
keratoconus, donor cornea quality, visual rehabilitation, penetration keratoplasty, coefficient of reflectivity of corneal endothelial cells (CRCEC)
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 3 (145), 2018 year, 125-133 pages, index UDK 617.713-007.64-089.843