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Primary failure of corneal graft after penetrating keratoplasty: a clinical case

Poster Details

First Author: M.Shanturova RUSSIA

Co Author(s):    N. Senchenko                    

Abstract Details

Purpose:

To present a case of successful treatment of the primary failure of corneal graft after penetrating keratoplasty by regrafting in combination with topical application of immuno-suppressive drugs in the postoperative period.

Setting:

S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk, Russia

Methods:

Patient S. 58 years old with vascularized corneal leukoma of right eye. Penetrating keratoplasty was made with keratoplastic material 'Material for the recovery of cornea' (LLC 'AYLAB'), extracapsular cataract extraction with IOL implantation was performed. On first day there were a mild edema of graft, folds of Descemet's membrane. Graft edema increased, despite treatment. On the 6th day after surgery the marked edema, bullous changes in the epithelium, exfoliation of the graft anterior layers were noted. Taking into account the lack of effect of treatment and a negative dynamics the patient underwent regrafting in 8 days after surgery.

Results:

Repeated keratoplasty was performed using canned keratoplasty material. We used the original graft diameter. Intra- and post-operative periods were uncomplicated. Histological examination of remote corneal disk revealed gross structural changes in all layers of the graft: ruptures of Descemet's membrane and layer of endothelial cells, edema and exfoliation of the stroma and pithelium. Taking into account the high degree of immune conflict probability, 1 drop, per 2 times a day cyclosporin eyedrops 0.05% (Restasis 0.4 ml) were added to the conventional regimen. Transplant engraftment was transparent. During 1, 3, 6 months of follow-up its condition was stable, transplant was transparent.

Conclusions:

In the case of primary failure of the corneal graft after penetrating keratoplasty the conservative treatment has no effect. The only treatment in this situation is regrafting in the early stages. To reduce the risk of immune conflict in the complex postoperative therapy the topically applied immunosuppressive drugs - 0.05% cyclosporine eye drops are useful.

Financial Disclosure:

NONE

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