ESCRS - CR34 - CLINICAL CASE OF THE USE OF THERAPEUTIC PLASMAPHERESIS TO PREVENT CORNEAL GRAFT IMMUNE REJECTION IN A PATIENT PRIOR TO HIGH-RISK KERATOPLASTY

CLINICAL CASE OF THE USE OF THERAPEUTIC PLASMAPHERESIS TO PREVENT CORNEAL GRAFT IMMUNE REJECTION IN A PATIENT PRIOR TO HIGH-RISK KERATOPLASTY

Published 2022 - 26th ESCRS Winter Meeting

Reference: CR34 | Type: Cornea Day Case Presentations | DOI: 10.82333/c1bx-gv57

Authors: Victoria Myasnikova* 1 , Sergey Sakhnov 2 , Denis Nefedov 3 , Alexey Klokov 3 , Ruset Shu 1 , Tamriko Zakaraiia 1

1Department of Science,S. Fyodorov Eye Microsurgery Federal State Institution,Krasnodar,Russian Federation, 2Department of Administration,S. Fyodorov Eye Microsurgery Federal State Institution,Krasnodar,Russian Federation, 3Department of Surgery,S. Fyodorov Eye Microsurgery Federal State Institution,Krasnodar,Russian Federation

We give an example of a complex preoperative preparation of the patient before keratoplasty. The purpose of our case report is to demonstrate the effectiveness of plasmapheresis in the preoperative period in patients undergoing keratoplasty.

This clinical case was followed at The S Fyodorov Eye Microsurgery Federal State Institution - Krasnodar, Russia

 

On 15.07.2020, patient G., 56 years old, received a thermal burn in his right eye while starting a campfire, the same year cement got into his right eye. He was treated at his place of residence. On 12.04.2021 the patient in our clinic was diagnosed with corneal degeneration and high risk factors for graft rejection in the postoperative period: keratouveitis, secondary ophthalmohypertension, limbal neovascularisation, deep corneal opacity. The patient is admitted to the hospital and preoperative preparation: antibiotics, anti-inflammatories, corticosteroids, midriatics, keratoprotectors. From 13.04.2021 to 19.04.2021 3 sessions of plasmapheresis are carried out. The inflammatory process is solved, the patient underwent a penetrating keratoplasty with femtolaser-assisted OD on April 15, 2021. At discharge on 26.04.2021 local OD status: cornea under MCL, almost completely epithelialized, descemetal membrane folds, sutures adapted. Anterior chamber 2 mm deep, moisture clear. The iris is subatrophic, the pigmentary border is partially leached. Cornea - clouding in the nucleus. Pale pink, clear borders under flare. In 1 month, on 13.05.2021 local status OD: conjunctiva pale pink, no discharge, cornea under ICD, complete epithelialization, nodular sutures 16 units, satisfactory, endothelial tuberosity. Anterior chamber 2 mm deep, moisture clear. Subatrophic iris, pigmentary fringe partially leached, lens - clouding in the nucleus. Advised to continue early treatment. In 3 months, 22.07.2021 local status OD: conjunctiva pale pink, no discharge, graft is almost transparent, epithelium is rough, staining at 2-3 o'clock in paraoptics, nodal sutures 16 units, good, endothelium b/o. Anterior chamber 2 mm deep, moisture clear. Subatrophic iris, pigmentary fringe partially leached, lens - clouding in the nucleus. Pale pink, clear margins under the flare.

Plasmapheresis has proven to be an effective method of combating complications at any stage of the management of a patient requiring corneal transplantation. As a result of the planned surgical procedure, the patient was able to regain corneal transparency. The post-operative DOC was 0.1 (20/200 or 6/60), giving the prospect of higher vision in the future. The patient was satisfied with the result.