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Redo penetrating keratoplasty: indications, visual outcome and complications

Poster Details

First Author: K.Mahmood PAKISTAN

Co Author(s):                        

Abstract Details

Purpose:

PKP is still the preferred choice of corneal transplantation in major part of the world. Redo PK is a need when primary graft is affected. The Redo corneal graft indications are graft failure either early or late, corneal infections, OSD, and /or graft rejections. In developing nations and tropical areas like Pakistan the above factors are all relevant in different ratios. As the corneal banking is lacking so we have to rely upon the corneal donor tissue even of lower endothelial cell count. The weather conditions commonly affect the health of the cornea predispose fungal / bacterial infections.

Setting:

The study was conducted at Aadil Hospital and Avicenna Medical College and Hospital, Lahore Pakistan

Methods:

A total of 124 cases underwent for redo PK during the period of Feb 2014 to Sep 2016. All cases were having full thickness graft as a first procedure. Redo grafting was done in following indications; 19 due to primary graft failure, 27 late graft failure, healed corneal scar in 39 fungal keratitis, 12 bacterial keratitis, 1 acanthamoeba keratitis, 21 rejected grafts due to OSD and 5 due to glaucoma. Second procedure done on an average of 4 months to 1 year. Visual acuity was reduced to HM �â�€�“ CF. The donor tissue was 0.25-0.50mm larger than the primary graft.

Results:

Out of 124 redo PK, the donor survival was 87%. The clarity of the tissue was excellent in cases of graft failures either primary or secondary. Where OSD was associated, cyclosporine was given twice a day upto 6-8 months combined with subconjunctival avastin injection both pre and post op. Topical antifungal continued for 4 months post-op. 48 eyes underwent Redo PK were having IOLs. The clarity of the graft was poor in 8 cases who were associated OSD. The post-op VA improved to 6/9 in 55% of cases and it ranged in 6/12-6/18 in 37% and CF in 8%.

Conclusions:

Redo PKP is a challenging job. The success of secondary grafting depends on the detailed pre-op workup and critical follow-up. OSD is still more crucial and the most important tip in our cases was the use of topical cyclosporine, s/c avastin and plenty of lubrication. Healed fungal keratitis cases required long term use of antifungal. The survival of the corneal graft tissue was very good in cases where we performed surgery in graft failures with good endothelial cell count.

Financial Disclosure:

NONE

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