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Outcomes of repeat corneal transplantation in failed therapeutic corneal grafts with retro corneal membranes

Poster Details

First Author: T.Chowdhury INDIA

Co Author(s):                        

Abstract Details

Purpose:

To evaluate the role of repeat corneal transplantation in failed therapeutic corneal grafts with retro corneal membranes (RCM) which was performed for the management of infective keratitis and to study the outcomes in regard to graft survival and secondary glaucoma.

Setting:

Disha Eye Hospitals Private Limited, Kolkata, India.

Methods:

It is a retrospective study of 14 eyes that underwent repeat corneal transplantation between Feb. 2011 till Aug. 2014. Previous therapeutic corneal grafting were performed in culture proven 9 eyes with fungal and 2 eyes with bacterial corneal ulcer. In 3 eyes with infective keratitis, no organisms could be detected. Pre-operatively, all eyes had ultra sound biomicroscopy (UBM) and anterior segment OCT to know the extent of RCM. Viscodissection of the RCM from visual axis tried in 6 eyes without much benefit. The mean time gap between first and second graft was 7.7 (range 4 to 11) months.

Results:

All14 eyes, underwent cataract surgery during repeat corneal transplantation with membranectomy and synechiolysis. Only in 4 eyes, multipiece IOL could be implanted after ECCE, rest 10 eyes remained aphake. 7 eyes needed anterior vitrectomy. Follow up ranged from 6 months till 4 years. At last follow up, 3 eyes had a graft clarity of 4+ and 6 eyes had a graft clarity of 2+. In 5 eyes, the graft failed because of secondary glaucoma. 2 eyes with IOL and 4 eyes with anterior vitrectomy had 2 episodes acute graft rejection. Only 2 patients had BCVA of 6/60, 1 had BCVA of 3/60, 4 had BCVA of CFCF, 4 had BCVA of PL+ and 3 eyes were PL negative.

Conclusions:

Therapeutic corneal grafting for the management of fulminant infective keratitis is quite challenging and mostly done to achieve the anatomical integrity of the eye . But in few cases, there were development of retro corneal membranes due to severe post-operative inflammation with profound graft edema and graft failure. Viscodissection of the RCM out of visual axis may be tried but in most cases has not much benefit. The long term results of repeat corneal transplantation are also not gratifying unless therapeutic intervention is done earlier and secondary glaucoma is properly controlled.

Financial Disclosure:

NONE

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