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Management of a case with recurrent graft rejection after spontaneous perforation due to underlying herpetic corneal disease

Poster Details

First Author: C.Utine TURKEY

Co Author(s):    M. Altunsoy                    

Abstract Details

Purpose:

To report the management of a 64 year old male patient with penetrating keratoplasty (PK) with intense pre- and postoperative medical treatment, who had been initially referred for keratoprosthesis surgery in the right eye for an opaque and vascularized corneal re-graft in 2012.

Setting:

Yeditepe University, Department of Ophthalmology, Istanbul

Methods:

Patient had a history of spontaneous corneal perforation in 2002 (first PK); and corneal graft rejection in 2007 (second PK). This cornea was rejected shortly after surgery, after which he had several subconjunctival bevacizumab injections with no significant improvement. Additionally he underwent right frontal craniotomy and meningioma excision in 2011 after which he had left hemiparesia and left visual field in both eyes. Best corrected visual acuities (BCVA) were hand motion OD; 0.6 with -0.75(-2.75@90) OS. Right eye fundus could not be evaluated; left eye optic disc was somewhat pale. Visual field test yielded left hemianopia OS; was inconclusive OD.

Results:

Auto-immune markers (RF, ANA, SS-A, SS-B, anti-thyroglobulin) were negative. After topical bevacizumab 1% qid for 1 year and (PO) valacyclovir 1000 mg tid for a week, right eye PK, cataract extraction and amniotic membrane implantation were performed. Postoperatively topical prednisolone acetate, q24h was started, tapered very slowly after 8 weeks and continued bid for a year. Antiviral treatment was reduced to 500 mg bid after 1 week; continued until after the sutures were removed and a Yag-laser capsulotomy was performed for posterior capsule opacification at 1st year. At postoperative 15th month, graft was clear and BCVA was 1.0p with -4.50(-2.75@50).

Conclusions:

Long term medical treatment to prepare the ocular surface for a corneal graft surgery seems to improve the chance for postoperative visual success and prognosis of the corneal graft.

Financial Disclosure:

NONE

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