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Penetrating rekeratoplasty in patients with secondary endothelial-epithelial dystrophy of the cornea
Session Title: Cornea Surgical II
Session Date/Time: Wednesday 09/10/2013 | 08:00-10:30
Paper Time: 09:40
Venue: Forum (Ground Floor)
First Author: : T.Churakov RUSSIA
Co Author(s): : T. Churakov
To evaluate biological and optical results of penetrating rekeratoplasty in patients with secondary endothelial-epithelial dystrophy after previously performed penetrating keratoplasty.
Academician S.N. Fedorov St.Petersburg Branch of the IR&TC "Eye microsurgery", St.Petersburg, Russia.
The study group included 67 patients aged 20 to 82 years after rekeratoplasty against the background of secondary endothelial-epithelial corneal dystrophy. The control group included patients to whom the penetrating keratoplasty was performed for the first time. In addition to the standard methods of ophthalmological examination, the optical coherence tomography, ultrasonic A-and B-scan, keratopachymetry and counting density of endothelial cells were used.
In all 56 operations were used fresh corneas, taken after 6-18 hours of the donor"s death. The criterion of suitability of a material was density of endothelial cells of at least 2000 cells per 1 sq. mm. The conventional methods of forming the bed, cutting out and fixing the graft (from the epithelium) of diameter 7.0 - 8.5 mm were used. Clinical groups in terms of volume and nature of the manipulations on the structures of the anterior segment were similar and comparable.
In the main and the control group were as follows postoperative complications: graft disease - 10.6% (6.6%), iridocyclitis - 9.3% (3%), hyphema - 5.3% (1.9%); IOP elevation (in patients with normal preoperative IOP) - 10.5% (5.3%); iridocorneal fusion - 7.3% (4%); retrocorneal membrane - 0.6% (0%); other - 5 % (5.3%).
Transparent engraftment in the main and the control group in 1 year, respectively, observed in 77.3% and 85.0%, translucent engraftment - 17.3% and 10.4%, turbid engraftment - 5.3% and 4.6%. In 3 years after operation significant progressive loss of endothelial cells in both groups (P<0.05) was revealed, which reduced the index of engraftment in the study group to 33.9%, and in the control group to 26.8%.
Best corrected visual acuity in 1 year after surgery of less than 0.05 was determined in the main and control group, respectively, in 27.9% and 11.7% of patients, 0.06-0.09 - 21.3% and 16.8% , 0.1-0.4 -31.9% and 45.4%, and more than 0.5 in 18.7% and 26.1%. Best corrected visual acuity in 3 years after surgery in patients of the main group decreased by 37.5%, whereas in the control group - only by 30.4% (P <0.03).
1. The study of the biological and optical results of the keratoplasty and rekeratoplasty significantly revealed that the results may be comparable, but only in those cases when rekeratoplasty does not require additional manipulations on the other structures of the eye.
2. It was identified a direct correlation of functional results of rekeratoplasty and the volume of transaction, postoperative course, severity and duration of postoperative iridocyclitis and timely relief of graft versus host disease.
3. It was confirmed that one of the main factors of success of rekeratoplasty was the qualitative state of unpreserved donor graft and the endothelial cell density of at least 2000 cells in 1 sq. mm.