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Intrastromal rings to avoid rejection in penetrating keratoplasty

Poster Details

First Author: E.Infantes Molina SPAIN

Co Author(s):    J. Celis Sanchez   A. Fidalgo Broncano   E. Avendano Cantos   D. Mesa Varona   M. Pradas Gonzalez   F. Gonzalez Del Valle     

Abstract Details


To report eight clinical outcomes of patients with several corneal pathologies treated with penetrating keratoplasty. These corneas underwent the placement of a intrastromal ring which were initially designed for astigmatism control, but it was observed that possibly reduces the possibility of immune reactions against the graft.


La Mancha Centro General Hospital,Alcázar de San Juan, Ciudad Real,Spain


The intrastromal corneal ring is 8 mm in diameter consisting of cobalt, titanium and molybdenum, which is placed within the receptor stromal, through the creation of a pocket in the same surgical procedure of keratoplasty. We fixed the donor bottom to the recipient cornea with 16 loose suture of nylon 10-0. Our report includes the monitoring of 8 clinical cases with different pathologies for 4 years. Some eyes had been previously treated with penetrating keratoplasty presenting corneal graft rejection.


The average age of the 8 patients was 67 years. Preoperative pathology was previous rejection to penetrating transplant in 6 (75%) patients, 2 (25%) of them were retransplanted one more time. Half of patients had glaucoma with medical and surgical treatment. The mean of the best preoperatory visual acuity was 1.85 LogMAR, and 0.33 LogMAR at 4 years follow-up in our center. The concomitant pathologies were ocular hypertension in 4 patients, limbal insufficiency 3 cases and 2 cases suffered corneal infection. The presence of blood new vessels in the stromal that cross the ring was 0%. No type of immune reaction appeared during the follow up of our patients.


The survival of the 8 grafts to 4 years of follow-up was 100%. There were only a few superficial new vessels and no stromal neovascularization. This stromal ring probably reduces the immune reactions in penetrating keratoplasty with elevated risk factors for rejection.

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