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Penetran keratoplasti endikasyonları: Bir üçüncü basamak sağlık merkezi deneyimi

Yıl 2021, Cilt: 46 Sayı: 4, 1409 - 1418, 30.12.2021
https://doi.org/10.17826/cumj.983002

Öz

Amaç: Bu çalışmada bir üçüncü basamak sağlık merkezinde uygulanan penetran keratoplasti (PK) ameliyatlarının endikasyon dağılımının ve çalışma periyodu içerisinde bu dağılımda görülen değişimlerin incelenmesi amaçlanmıştır.
Gereç ve Yöntem: PK ameliyatı geçiren hastaların tıbbi kayıtları retrospektif olarak incelendi. Endikasyonlar; korneal skar, korneal distrofi, keratokonus, büllöz keratopati, regreft ve akut enfeksiyöz keratit olmak üzere altı ana kategori altında incelendi. Endikasyonların zaman içerisindeki değişimini inceleyebilmek amacıyla çalışma periyodu iki eşit zaman dilimine ayrıldı ve bu iki periyottaki veriler karşılaştırıldı.
Bulgular: İki yüz altmış üç hastanın (117 kadın [%44,5], 146 erkek [%55,5]) 303 gözü çalışmaya dahil edildi. Penetran keratoplastinin en sık endikasyonu korneal skarlar (76 göz, %25,1) idi. Enfeksiyöz keratit sekelleri (38/76, %50) korneal skar etyolojisi içerisinde ilk sırayı alırken, etkenlere göre dağılım incelendiğinde herpetik keratite bağlı sekeller (21/38, %55,2) en büyük alt grubu oluşturmaktaydı. Çalışma periyodunun 2. yarısında korneal distrofi nedeniyle uygulanan cerrahilerin oranının azaldığı, regreft uygulanan olguların oranının ise artış gösterdiği saptandı.
Sonuç: Çalışmamızda PK’nın en sık nedeni korneal skar olarak bulunmuştur.. Enfeksiyöz keratit ve korneal travma olguları açısından sağlık hizmetlerinin iyileştirilmesi; korneal distrofiler açısından ise akraba evliliklerinin önlenmesine yönelik sosyal projelerin ve genetik danışmanlık hizmetlerinin yaygınlaştırılması, bölgemizde korneal patolojiler kaynaklı görme kayıplarını azaltabilecektir.

Teşekkür

Bu çalışmadaki verilerin toplanması aşamasındaki katkılarından dolayı Çukurova Üniversitesi Tıp Fakültesi Göz Hastalıkları Anabilim Dalı Kornea Bankası teknisyeni Erhan Cansız’a teşekkürlerimizi sunarız.

Kaynakça

  • Frigo AC, Fasolo A, Capuzzo C, Fornea M, Bellucci R, Busin M et al. CORTES Study Group. Corneal transplantation activity over 7 years: changing trends for indications, patient demographics and surgical techniques from the Corneal Transplant Epidemiological Study (CORTES). Transplant Proc. 2015;47:528-35.
  • Al-Yousuf N, Al Alawi E, Mahmood A, Alzayani A, Al Sawad H, Alsetri H et al. Changing Indications for Penetrating Keratoplasty in Bahrain in a Tertiary Referral Centre. Clin Ophthalmol. 2021:15;1503-10.
  • Altay Y, Burcu A, Aksoy G, Ozdemir ES, Ornek F. Changing indications and techniques for corneal transplantations at a tertiary referral center in Turkey, from 1995 to 2014. Clin Ophthalmol. 2016:1;1007-13.
  • Dong PN, Han TN, Aldave AJ, Chau HT. Indications for and techniques of keratoplasty at Vietnam National Institute of Ophthalmology. Int J Ophthalmol. 2016;9:379-83.
  • Zirm EK. Eine erfolgreiche totale Keratoplastik (A successful total keratoplasty). 1906. Refract Corneal Surg. 1989;5:258-61.
  • Wang JY, Xie LX, Song XS, Zhao J. Trends in the indications for penetrating keratoplasty in Shandong, 2005-2010. Int J Ophthalmol. 2011;4:492-7.
  • Siganos CS, Tsiklis NS, Miltsakakis DG, Georgiadis NS, Georgiadou IN, Kymionis GD et al. Changing indications for penetrating keratoplasty in Greece, 1982-2006: A multicenter study. Cornea 2010;29:372–374.
  • Ghosheh FR, Cremona F, Ayres BD, Hammersmith KM, Cohen EJ, Raber IM et al. Indications for penetrating keratoplasty and associated procedures, 2001-2005. Eye Contact Lens. 2008;34:211-4.
  • Sony P, Sharma N, Sen S, Vajpayee RB. Indications of penetrating keratoplasty in northern India. Cornea. 2005;24:989-91.
  • Brady SE, Rapuano CJ, Arentsen JJ, Cohen EJ, Laibson PR. Clinical indications for and procedures associated with penetrating keratoplasty, 1983-1988. Am J Ophthalmol. 1989;108:118-22.
  • IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.
  • Al-Sharif EM, Alkharashi M. Indications, surgical procedures and outcomes of keratoplasty at a Tertiary University-based hospital: a review of 10 years' experience. Int Ophthalmol. 2021;41:957-72.
  • Bozkurt TK, Acar B, Kilavuzoglu AE, Akdemir MO, Hamilton DR, Cosar Yurteri CB et al. An 11-Year Review of Keratoplasty in a Tertiary Referral Center in Turkey: Changing Surgical Techniques for Similar Indications. Eye Contact Lens. 2017;43:364-70.
  • Matthaei M, Sandhaeger H, Hermel M, Adler W, Jun AS, Cursiefen C et al. Changing Indications in Penetrating Keratoplasty: A Systematic Review of 34 Years of Global Reporting. Transplantation. 2017;101:1387-99.
  • Bajracharya L, Gurung R, Demarchis EH, Oliva M, Ruit S, Tabin G. Indications for keratoplasty in Nepal: 2005 - 2010. Nepal J Ophthalmol. 2013;5:207-14.
  • Chen WL, Hu FR, Wang IJ. Changing indications for penetrating keratoplasty in Taiwan from 1987 to 1999. Cornea. 2001;20:141-4.
  • Dandona L, Ragu K, Janarthanan M, Naduvilath TJ, Shenoy R, Rao GN. Indications for penetrating keratoplasty in India. Indian J Ophthalmol. 1997;45:163-8.
  • Cengiz O, Köksal C, M, Erçalik NY, Eskiçirak B, Torun Acar B, Acar S. Penetran Keratoplasti Endikasyonları, 7 Yıllık Periyot. Journal of Glaucoma-Cataract, 2012;7(3).
  • Çubuk M, Koçluk Y, Özelbaykal B. Penetran Keratoplastili Olgularda Endikasyon Dağılımları ve Klinik Sonuçlarımız. Türkiye Klinikleri Oftalmoloji Dergisi. 2019;28:273-80.
  • Balsak S, Yildiz Ekinci D. Keratoplasty indications and outcomes: The experience of a tertiary health center in Southeastern of Turkey. Annals of Medical Research. 2019;26:1605-09.
  • Frucht-Pery J, Shtibel H, Solomon A, Siganos CS, Yassur Y, Pe'er J. Thirty years of penetrating keratoplasty in Israel. Cornea. 1997;16:16-20.
  • Cunningham WJ, Brookes NH, Twohill HC, Moffatt SL, Pendergrast DG, Stewart JM et al. Trends in the distribution of donor corneal tissue and indications for corneal transplantation: the New Zealand National Eye Bank Study 2000-2009. Clin Exp Ophthalmol. 2012;40:141-7.
  • Chaidaroon W, Ausayakhun S, Ngamtiphakorn S, Prasitsilp J. Clinical indications for penetrating keratoplasty in Maharaj Nakorn Chiang Mai Hospital, 1996-1999. J Med Assoc Thai. 2003;86:206-11.
  • Edwards M, Clover GM, Brookes N, Pendergrast D, Chaulk J, McGhee CN. Indications for corneal transplantation in New Zealand: 1991-1999. Cornea. 2002;21:152-5.
  • Mkanganwi N, Nondo SI, Guramatunhu S. Indications for corneal grafting in Zimbabwe. Cent Afr J Med. 2000;46:300-2.
  • Chowdhary A, Singh K. Spectrum of fungal keratitis in North India. Cornea. 2005;24:8-15.
  • Wilson, SE. Graft failure after penetrating keratoplasty. Survey of ophthalmology, 1990:34;325-56.
  • Módis L Jr, Szalai E, Facskó A, Fodor M, Komár T, Berta A. Corneal transplantation in Hungary (1946-2009). Clin Exp Ophthalmol. 2011;39:520-5.
  • Malkondu F, Arıkoğlu H, Erkoç Kaya D, Bozkurt B, Özkan F. Investigation of TGFBI (transforming growth factor beta-induced) Gene Mutations in Families with Granular Corneal Dystrophy Type 1 in the Konya Region. Turk J Ophthalmol. 2020;29:64-70.
  • Utine C, Utine G. Genetics in Ophthalmology II-Anterior Segment Diseases. Turk J Ophthalmol 2012;42: 378-85.
  • Yaylacioglu Tuncay F, Guntekin Ergun S, Oner A, Turan A, Ozmert E, Ergun MA et al. Inherited eye diseases in Turkey: Current approaches and future directions. Am J Med Genet C Semin Med Genet. 2020;184:773-81.
  • Güneş, A. Indications For Keratoplasty. The Medical Journal Of Haydarpaşa Numune Training and Research Hospital. 2012;52:63-6.
  • Genç O, Bulut N, Ort A. Keratoplasti Ameliyatı Endikasyonları ve Ameliyat Teknikleri. J Kartal TR. 2012;23:61-4.
  • Kaplan S, Pinar G, Kaplan B, Aslantekin F, Karabulut E, Ayar B et al. The prevalence of consanguineous marriages and affecting factors in Turkey: a national survey. J Biosoc Sci. 2016;48:616-30.
  • TFSS (2011) Family Structure in Turkey Survey, Ministry of Family and Social Policy (Turkey) (2011). URL: http://www.cocukhaklariizleme.org/wp-content/uploads/turkiyenin-aile-yapisiarastirmasi-20111.pdf. Erişim tarihi: 14.06.2021.
  • Cosar CB, Sridhar MS, Cohen EJ, Held EL, Alvim Pde T, Rapuano CJ et al. Indications for penetrating keratoplasty and associated procedures, 1996-2000. Cornea. 2002;21:148-51.
  • Dobbins KR, Price FW Jr, Whitson WE. Trends in the indications for penetrating keratoplasty in the midwestern United States. Cornea. 2000;19:813-6.
  • Thompson RW Jr, Price MO, Bowers PJ, Price FW Jr. Long-term graft survival after penetrating keratoplasty. Ophthalmology. 2003;110:1396-402.
  • Mamalis N, Anderson CW, Kreisler KR, Lundergan MK, Olson RJ. Changing trends in the indications for penetrating keratoplasty. Arch Ophthalmol. 1992;110:1409-11.
  • Kanavi MR, Javadi MA, Sanagoo M. Indications for penetrating keratoplasty in Iran. Cornea. 2007;26:561-3.
  • Yahalom C, Mechoulam H, Solomon A, Raiskup FD, Peer J, Frucht-Pery J. Forty years of changing indications in penetrating keratoplasty in Israel. Cornea. 2005;24:256-8.
  • Poinard C, Tuppin P, Loty B, Delbosc B. Bilan de la liste nationale d'attente de greffe de cornée française créée en 1999: taux d'inscription, flux, indications et caractéristiques des malades [The French national waiting list for keratoplasty created in 1999: patient registration, indications, characteristics, and turnover]. J Fr Ophtalmol. 2003;26:911-9.
  • Keenan TD, Jones MN, Rushton S, Carley FM; National Health Service Blood and Transplant Ocular Tissue Advisory Group and Contributing Ophthalmologists (Ocular Tissue Advisory Group Audit Study 8). Trends in the indications for corneal graft surgery in the United Kingdom: 1999 through 2009. Arch Ophthalmol. 2012;130:621-8.
  • Galvis V, Tello A, Gomez AJ, Rangel CM, Prada AM, Camacho PA. Corneal transplantation at an ophthalmological referral center in Colombia: indications and techniques (2004-2011). Open Ophthalmol J. 2013;7:30-3.
  • Ting DS, Sau CY, Srinivasan S, Ramaesh K, Mantry S, Roberts F. Changing trends in keratoplasty in the West of Scotland: a 10-year review. Br J Ophthalmol. 2012;96:405-8.
  • Wang J, Hasenfus A, Schirra F, Bohle RM, Seitz B, Szentmáry N. Changing indications for penetrating keratoplasty in Homburg/Saar from 2001 to 2010--histopathology of 1,200 corneal buttons. Graefes Arch Clin Exp Ophthalmol. 2013;251:797-802.
  • Tan JC, Holland SP, Dubord PJ, Moloney G, McCarthy M, Yeung SN. Evolving indications for and trends in keratoplasty in British Columbia, Canada, from 2002 to 2011: a 10-year review. Cornea. 2014;33:252-6.

Indications for penetrating keratoplasty: A single tertiary health clinic experience

Yıl 2021, Cilt: 46 Sayı: 4, 1409 - 1418, 30.12.2021
https://doi.org/10.17826/cumj.983002

Öz

Purpose: The aim of this study was to investigate the indication distribution for penetrating keratoplasty (PK) surgeries performed in our clinic and the changes observed in this distribution during the study period.
Materials and Methods: Medical records of patients who underwent PK were retrospectively reviewed. Indications were examined under six main categories; corneal scarring, corneal dystrophy, keratoconus, bullous keratopathy, regraft and acute infectious keratitis. In order to examine the changes in indications over time, the study period was divided into two equal time periods and the data in these periods were compared.
Results: 303 eyes of 263 patients (117 women [44.5%], 146 men [55.5%]) were included in the study. The most common indication for penetrating keratoplasty was corneal scars (76 eyes, 25.1%). While infectious keratitis sequelaes (38/76, 50%) took the first place in the etiology of corneal scarring, sequelaes due to herpetic keratitis (21/38, 55.2%) were the largest subgroup whereas the distribution according to the microbial agents was examined. In the second half of the study period, the rate of surgeries performed due to corneal dystrophy decreased, whereas the rate of patients who underwent regraft increased.
Conclusion: The most common indication for PK was corneal scarring in this study. Improving health services in terms of infectious keratitis and corneal trauma cases; dissemination of social projects and genetic counseling services for the prevention of consanguineous marriages in terms of corneal dystrophies will reduce vision loss due to corneal pathologies in this region.

Kaynakça

  • Frigo AC, Fasolo A, Capuzzo C, Fornea M, Bellucci R, Busin M et al. CORTES Study Group. Corneal transplantation activity over 7 years: changing trends for indications, patient demographics and surgical techniques from the Corneal Transplant Epidemiological Study (CORTES). Transplant Proc. 2015;47:528-35.
  • Al-Yousuf N, Al Alawi E, Mahmood A, Alzayani A, Al Sawad H, Alsetri H et al. Changing Indications for Penetrating Keratoplasty in Bahrain in a Tertiary Referral Centre. Clin Ophthalmol. 2021:15;1503-10.
  • Altay Y, Burcu A, Aksoy G, Ozdemir ES, Ornek F. Changing indications and techniques for corneal transplantations at a tertiary referral center in Turkey, from 1995 to 2014. Clin Ophthalmol. 2016:1;1007-13.
  • Dong PN, Han TN, Aldave AJ, Chau HT. Indications for and techniques of keratoplasty at Vietnam National Institute of Ophthalmology. Int J Ophthalmol. 2016;9:379-83.
  • Zirm EK. Eine erfolgreiche totale Keratoplastik (A successful total keratoplasty). 1906. Refract Corneal Surg. 1989;5:258-61.
  • Wang JY, Xie LX, Song XS, Zhao J. Trends in the indications for penetrating keratoplasty in Shandong, 2005-2010. Int J Ophthalmol. 2011;4:492-7.
  • Siganos CS, Tsiklis NS, Miltsakakis DG, Georgiadis NS, Georgiadou IN, Kymionis GD et al. Changing indications for penetrating keratoplasty in Greece, 1982-2006: A multicenter study. Cornea 2010;29:372–374.
  • Ghosheh FR, Cremona F, Ayres BD, Hammersmith KM, Cohen EJ, Raber IM et al. Indications for penetrating keratoplasty and associated procedures, 2001-2005. Eye Contact Lens. 2008;34:211-4.
  • Sony P, Sharma N, Sen S, Vajpayee RB. Indications of penetrating keratoplasty in northern India. Cornea. 2005;24:989-91.
  • Brady SE, Rapuano CJ, Arentsen JJ, Cohen EJ, Laibson PR. Clinical indications for and procedures associated with penetrating keratoplasty, 1983-1988. Am J Ophthalmol. 1989;108:118-22.
  • IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.
  • Al-Sharif EM, Alkharashi M. Indications, surgical procedures and outcomes of keratoplasty at a Tertiary University-based hospital: a review of 10 years' experience. Int Ophthalmol. 2021;41:957-72.
  • Bozkurt TK, Acar B, Kilavuzoglu AE, Akdemir MO, Hamilton DR, Cosar Yurteri CB et al. An 11-Year Review of Keratoplasty in a Tertiary Referral Center in Turkey: Changing Surgical Techniques for Similar Indications. Eye Contact Lens. 2017;43:364-70.
  • Matthaei M, Sandhaeger H, Hermel M, Adler W, Jun AS, Cursiefen C et al. Changing Indications in Penetrating Keratoplasty: A Systematic Review of 34 Years of Global Reporting. Transplantation. 2017;101:1387-99.
  • Bajracharya L, Gurung R, Demarchis EH, Oliva M, Ruit S, Tabin G. Indications for keratoplasty in Nepal: 2005 - 2010. Nepal J Ophthalmol. 2013;5:207-14.
  • Chen WL, Hu FR, Wang IJ. Changing indications for penetrating keratoplasty in Taiwan from 1987 to 1999. Cornea. 2001;20:141-4.
  • Dandona L, Ragu K, Janarthanan M, Naduvilath TJ, Shenoy R, Rao GN. Indications for penetrating keratoplasty in India. Indian J Ophthalmol. 1997;45:163-8.
  • Cengiz O, Köksal C, M, Erçalik NY, Eskiçirak B, Torun Acar B, Acar S. Penetran Keratoplasti Endikasyonları, 7 Yıllık Periyot. Journal of Glaucoma-Cataract, 2012;7(3).
  • Çubuk M, Koçluk Y, Özelbaykal B. Penetran Keratoplastili Olgularda Endikasyon Dağılımları ve Klinik Sonuçlarımız. Türkiye Klinikleri Oftalmoloji Dergisi. 2019;28:273-80.
  • Balsak S, Yildiz Ekinci D. Keratoplasty indications and outcomes: The experience of a tertiary health center in Southeastern of Turkey. Annals of Medical Research. 2019;26:1605-09.
  • Frucht-Pery J, Shtibel H, Solomon A, Siganos CS, Yassur Y, Pe'er J. Thirty years of penetrating keratoplasty in Israel. Cornea. 1997;16:16-20.
  • Cunningham WJ, Brookes NH, Twohill HC, Moffatt SL, Pendergrast DG, Stewart JM et al. Trends in the distribution of donor corneal tissue and indications for corneal transplantation: the New Zealand National Eye Bank Study 2000-2009. Clin Exp Ophthalmol. 2012;40:141-7.
  • Chaidaroon W, Ausayakhun S, Ngamtiphakorn S, Prasitsilp J. Clinical indications for penetrating keratoplasty in Maharaj Nakorn Chiang Mai Hospital, 1996-1999. J Med Assoc Thai. 2003;86:206-11.
  • Edwards M, Clover GM, Brookes N, Pendergrast D, Chaulk J, McGhee CN. Indications for corneal transplantation in New Zealand: 1991-1999. Cornea. 2002;21:152-5.
  • Mkanganwi N, Nondo SI, Guramatunhu S. Indications for corneal grafting in Zimbabwe. Cent Afr J Med. 2000;46:300-2.
  • Chowdhary A, Singh K. Spectrum of fungal keratitis in North India. Cornea. 2005;24:8-15.
  • Wilson, SE. Graft failure after penetrating keratoplasty. Survey of ophthalmology, 1990:34;325-56.
  • Módis L Jr, Szalai E, Facskó A, Fodor M, Komár T, Berta A. Corneal transplantation in Hungary (1946-2009). Clin Exp Ophthalmol. 2011;39:520-5.
  • Malkondu F, Arıkoğlu H, Erkoç Kaya D, Bozkurt B, Özkan F. Investigation of TGFBI (transforming growth factor beta-induced) Gene Mutations in Families with Granular Corneal Dystrophy Type 1 in the Konya Region. Turk J Ophthalmol. 2020;29:64-70.
  • Utine C, Utine G. Genetics in Ophthalmology II-Anterior Segment Diseases. Turk J Ophthalmol 2012;42: 378-85.
  • Yaylacioglu Tuncay F, Guntekin Ergun S, Oner A, Turan A, Ozmert E, Ergun MA et al. Inherited eye diseases in Turkey: Current approaches and future directions. Am J Med Genet C Semin Med Genet. 2020;184:773-81.
  • Güneş, A. Indications For Keratoplasty. The Medical Journal Of Haydarpaşa Numune Training and Research Hospital. 2012;52:63-6.
  • Genç O, Bulut N, Ort A. Keratoplasti Ameliyatı Endikasyonları ve Ameliyat Teknikleri. J Kartal TR. 2012;23:61-4.
  • Kaplan S, Pinar G, Kaplan B, Aslantekin F, Karabulut E, Ayar B et al. The prevalence of consanguineous marriages and affecting factors in Turkey: a national survey. J Biosoc Sci. 2016;48:616-30.
  • TFSS (2011) Family Structure in Turkey Survey, Ministry of Family and Social Policy (Turkey) (2011). URL: http://www.cocukhaklariizleme.org/wp-content/uploads/turkiyenin-aile-yapisiarastirmasi-20111.pdf. Erişim tarihi: 14.06.2021.
  • Cosar CB, Sridhar MS, Cohen EJ, Held EL, Alvim Pde T, Rapuano CJ et al. Indications for penetrating keratoplasty and associated procedures, 1996-2000. Cornea. 2002;21:148-51.
  • Dobbins KR, Price FW Jr, Whitson WE. Trends in the indications for penetrating keratoplasty in the midwestern United States. Cornea. 2000;19:813-6.
  • Thompson RW Jr, Price MO, Bowers PJ, Price FW Jr. Long-term graft survival after penetrating keratoplasty. Ophthalmology. 2003;110:1396-402.
  • Mamalis N, Anderson CW, Kreisler KR, Lundergan MK, Olson RJ. Changing trends in the indications for penetrating keratoplasty. Arch Ophthalmol. 1992;110:1409-11.
  • Kanavi MR, Javadi MA, Sanagoo M. Indications for penetrating keratoplasty in Iran. Cornea. 2007;26:561-3.
  • Yahalom C, Mechoulam H, Solomon A, Raiskup FD, Peer J, Frucht-Pery J. Forty years of changing indications in penetrating keratoplasty in Israel. Cornea. 2005;24:256-8.
  • Poinard C, Tuppin P, Loty B, Delbosc B. Bilan de la liste nationale d'attente de greffe de cornée française créée en 1999: taux d'inscription, flux, indications et caractéristiques des malades [The French national waiting list for keratoplasty created in 1999: patient registration, indications, characteristics, and turnover]. J Fr Ophtalmol. 2003;26:911-9.
  • Keenan TD, Jones MN, Rushton S, Carley FM; National Health Service Blood and Transplant Ocular Tissue Advisory Group and Contributing Ophthalmologists (Ocular Tissue Advisory Group Audit Study 8). Trends in the indications for corneal graft surgery in the United Kingdom: 1999 through 2009. Arch Ophthalmol. 2012;130:621-8.
  • Galvis V, Tello A, Gomez AJ, Rangel CM, Prada AM, Camacho PA. Corneal transplantation at an ophthalmological referral center in Colombia: indications and techniques (2004-2011). Open Ophthalmol J. 2013;7:30-3.
  • Ting DS, Sau CY, Srinivasan S, Ramaesh K, Mantry S, Roberts F. Changing trends in keratoplasty in the West of Scotland: a 10-year review. Br J Ophthalmol. 2012;96:405-8.
  • Wang J, Hasenfus A, Schirra F, Bohle RM, Seitz B, Szentmáry N. Changing indications for penetrating keratoplasty in Homburg/Saar from 2001 to 2010--histopathology of 1,200 corneal buttons. Graefes Arch Clin Exp Ophthalmol. 2013;251:797-802.
  • Tan JC, Holland SP, Dubord PJ, Moloney G, McCarthy M, Yeung SN. Evolving indications for and trends in keratoplasty in British Columbia, Canada, from 2002 to 2011: a 10-year review. Cornea. 2014;33:252-6.
Toplam 47 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Araştırma
Yazarlar

İbrahim İnan Harbiyeli 0000-0003-2586-1096

Elif Erdem 0000-0002-3157-6913

Anıl Uysal 0000-0001-6858-3423

Meltem Yağmur 0000-0002-7581-8056

Yayımlanma Tarihi 30 Aralık 2021
Kabul Tarihi 8 Eylül 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 46 Sayı: 4

Kaynak Göster

MLA Harbiyeli, İbrahim İnan vd. “Penetran Keratoplasti endikasyonları: Bir üçüncü Basamak sağlık Merkezi Deneyimi”. Cukurova Medical Journal, c. 46, sy. 4, 2021, ss. 1409-18, doi:10.17826/cumj.983002.