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Stromal rejection after deep anterior lamellar keratoplasty utilizing grafts of large-diameter (9mm)

Poster Details

First Author: G.Giannaccare ITALY

Co Author(s):    L. Sapigni   C. Bovone   V. Scorcia   M. Busin           

Abstract Details

Purpose:

To evaluate the incidence and outcomes of stromal rejection occurring after deep anterior lamellar keratoplasty (DALK) employing grafts of large diameter (9mm) in eyes with various types of stromal disease.

Setting:

Department of Ophthalmology, Villa Igea Hospital, Forl�Ã�¬, Italy; International Institute for Research and Training in Ophthalmology, Forl�Ã�¬, Italy.

Methods:

All medical charts of patients who underwent DALK since January 2012 at our Institution were reviewed. DALK was performed in a standardized fashion including: 9mm deep trephination of the recipient; pneumatic dissection; clearing of the central 6 mm by removal of the big-bubble ceiling or hand dissection; suturing of a 9 mm donor lamella. Each eye was assigned to either: Group 1=Keratoconus (KC); Group 2=Non-vascularized corneas other than KC; Group 3=Vascularized corneas. Episodes of stromal rejection and outcomes 6 months after treatment with topical dexamethasone 0.1% (2-hourly for 14 days and slowly tapered off over a 6-month period) were noted.

Results:

During the study period, in total 20/376 eyes (5.3%) of 352 patients experienced an episode of stromal rejection. Repeat rejection episodes were not seen. Stromal rejection was recorded in 17/286 eyes (5.9%) of Group 1, 2/55 eyes (3.6%) of Group 2 and 1/35 eyes (2.8%) of Group 3. The time interval between DALK and the onset of the rejection episode ranged from 1 to 24 months (average = 11.6 months). Within 6 months from onset, steroidal treatment had succeeded in reverting best-corrected visual acuity, central corneal thickness and endothelial cell count to pre-rejection values in all cases.

Conclusions:

Utilizing grafts of large diameter (9 mm) for DALK does not increase the risk of stromal rejection, regardless of the indication for surgery. DALK grafts larger than conventional ones (8-8.25 mm) used for penetrating keratoplasty may combine the advantages of minimizing the risk and adverse effects of immunologic rejection with those of improved optics related to the increased diameter.

Financial Disclosure:

NONE

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