Utilization of Residual Donor Tissue for Regrafting in Bullous Keratopathy After Corneal Transplantation
Postoperative endothelial cell loss following Descemet stripping endothelial keratoplasty (DSEK) remains a well-recognized clinical concern, with long-term follow-up demonstrating approximately 50% reduction in endothelial cell density by 5 years. Compounding this challenge, the critical shortage of corneal donors has severely limited the expansion of corneal transplantation programs in developing countries. In conventional penetrating keratoplasty, only the central 7-mm optical zone is typically harvested, whereas the peripheral donor tissue-whose endothelial cells are believed to exhibit superior viability-is routinely discarded.
To address these limitations, we describe the first-in-human use of three residual peripheral donor tissue segments, obtained after conventional keratoplasty, which were combined to perform corneal endothelial transplantation. This innovative approach substantially enhanced donor tissue utilization. Postoperatively, the patient achieved sustained corneal transparency with visual acuity improving from 20/500 to 20/50. Notably, the intersegmental gaps resolved progressively over time.
Extending this proof-of-concept case, we subsequently investigated the long-term stability and safety of residual donor tissue endothelial keratoplasty for bullous keratopathy, with comprehensive evaluation of postoperative visual acuity, intraocular pressure, corneal endothelial cell density, and refractive outcomes. This study aims to establish evidence-based support for the safety and efficacy of utilizing residual graft tissue in corneal endothelial transplantation.
Visão geral do estudo
Status
Condições
Intervenção / Tratamento
Tipo de estudo
Inscrição (Estimado)
Estágio
- Não aplicável
Contactos e Locais
Contato de estudo
- Nome: Xiaojuan Dong
- Número de telefone: 8613552338060
- E-mail: qingerdong@126.com
Locais de estudo
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Guangdong
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Guangzhou, Guangdong, China, 510070
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
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Contato:
- Ting Huang
- Número de telefone: 8613682205425
- E-mail: qingerdong@126.com
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Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
Aceita Voluntários Saudáveis
Gêneros Elegíveis para o Estudo
Descrição
Inclusion Criteria:
- Patients with bullous keratopathy of various etiologies, with a corneal thickness of ≥650 μm, refractory to medical treatment.
- Aged ≥18 years.
- The subject or their legally authorized guardian voluntarily consents to participate in this study and signs the informed consent form, with good compliance and willingness to attend follow-up visits.
Exclusion Criteria:
- Loss of vision in the fellow eye.
- Corneal or ocular surface infection within 30 days prior to enrollment.
- Severe dry eye, with Schirmer's test < 5 mm.
- Concurrent diseases that may affect the transplantation or prognosis, such as advanced glaucoma or retinal diseases.
- Ocular surface malignancy.
- Severe cicatrizing ocular disease; conjunctival scarring with fornix shortening.
- Recent HbA1c > 6.5%, or uncontrolled diabetes mellitus.
- Severe impairment of vital organs, including the heart, liver, or kidneys.
- Severe hematologic or endocrine disorders, or a history of such disorders.
- Active autoimmune disease.
- Current signs of infection, including fever or ongoing antibiotic therapy.
- Psychiatric disorders.
- Pregnant or lactating women, or women planning pregnancy within 2 years.
- Participation in other clinical studies or trials within 3 months.
- Subjects who lack compliance with the study or the capacity to sign the informed consent form.
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: N / D
- Modelo Intervencional: Atribuição de grupo único
- Mascaramento: Nenhum (rótulo aberto)
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
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Experimental: Postoperative corneal thickness
To observe postoperative corneal thickness in patients with bullous keratopathy treated by endothelial keratoplasty using residual donor tissue following previous corneal transplantation. |
Endothelial keratoplasty using residual donor tissue from previous corneal transplantation |
O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Corneal thickness
Prazo: Preoperatively and at postoperative day 1; at 1 and 2 weeks; and at 1, 2, 3, 6, and 12 months.
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Corneal thickness was measured preoperatively and postoperatively using an iVue OCT (OPTOVUE) or another OCT instrument, and the changes were compared. |
Preoperatively and at postoperative day 1; at 1 and 2 weeks; and at 1, 2, 3, 6, and 12 months.
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Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Best-corrected visual acuity (BCVA)
Prazo: Preoperatively and at postoperative day 1; at 1 and 2 weeks; and at 1, 2, 3, 6, and 12 months.
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Preoperative and postoperative visual acuity was assessed using the ETDRS chart. |
Preoperatively and at postoperative day 1; at 1 and 2 weeks; and at 1, 2, 3, 6, and 12 months.
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Spherical equivalent (SE)
Prazo: Preoperatively and at postoperative day 1; at 1 and 2 weeks; and at 1, 2, 3, 6, and 12 months.
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Preoperative and postoperative SE was measured using a phoropter and an autorefractor, and differences before and after surgery as well as between the two groups were compared. |
Preoperatively and at postoperative day 1; at 1 and 2 weeks; and at 1, 2, 3, 6, and 12 months.
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Corneal edema and opacity
Prazo: Preoperatively and at postoperative day 1; at 1 and 2 weeks; and at 1, 2, 3, 6, and 12 months.
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The degree of corneal edema and opacity was examined by slit-lamp microscopy. |
Preoperatively and at postoperative day 1; at 1 and 2 weeks; and at 1, 2, 3, 6, and 12 months.
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Corneal endothelial cell count
Prazo: At postoperative day 1 and at 1 week, 2 weeks, 1 month, 2 months, 3 months, 6 months, and 12 months.
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Postoperative corneal endothelial cell density was measured using laser confocal microscopy (Heidelberg Engineering, Germany) or a corneal endothelial specular microscope, and changes were compared. |
At postoperative day 1 and at 1 week, 2 weeks, 1 month, 2 months, 3 months, 6 months, and 12 months.
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Donor graft detachment
Prazo: At postoperative day 1 and at 1 week, 2 weeks, 1 month, 2 months, 3 months, 6 months, and 12 months.
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Graft adhesion/apposition was evaluated by slit-lamp microscopy and OCT. |
At postoperative day 1 and at 1 week, 2 weeks, 1 month, 2 months, 3 months, 6 months, and 12 months.
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Intraocular pressure (IOP)
Prazo: Preoperatively and at 1, 3, 6, and 12 months postoperatively.
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Preoperative and postoperative IOP was measured using a non-contact tonometer. |
Preoperatively and at 1, 3, 6, and 12 months postoperatively.
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Colaboradores e Investigadores
Patrocinador
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo (Estimado)
Conclusão Primária (Estimado)
Conclusão do estudo (Estimado)
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Real)
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Mais Informações
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Outros números de identificação do estudo
- 2026KYPJ038
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