THE BECOMING OF OCULAR SURFACE AFTER TRANSFIXING KERATOPLASTY: ABOUT 36 EYES.

The transfixing keratoplasty (KPT) often represents a last resort for the permanent losses of transparency and corneal architecture.The damaging of the graft is often secondary to an ocular surface abnormality.

The purpose of our study is to: Determine the profile of epithelial abnormalities in the postoperative period of KPT , as well as the donor and the host variables that influence the state of the graft’s epithelium.

We conducted a retrospective case study from December 2019 to March 2021 following the clinical evolution of 36 eyes after (KPT). We monitored the corneal epithelium for 6 months after surgery, using biomicroscopy, and fluorescein staining.The donor data analyzed were: age, sex, cause of death, time between death and preservation (DPT), time between collection and use of the graft in the recipient (TPU), total time (TT), state of graft epithelium and stroma.The host's data analyzed were: age, sex, indication of KPT, ocular surface condition, ocular comorbidity, local postoperative treatment.

The average age of the hosts was 43.5 ± 22.95.The average age of donors is between 50 to 75 years old. The corneal abnormalities observed in order of frequency are: superficial punctate keratitis (KPS), corneal ulcers <1/2 graft, corneal abscess, total corneal ulcer, in 86%, 36%, 8%, 4% respectively. These abnormalities decreased over time, and in some cases persisted after the 6th month.The age and sex of the donor significantly impacted the epithelial surface (p = 0.05 and 0.005 respectively), TPD, TPU and TT also had a significant influence on the corneal epithelium (p = 0.001, p = 0.05, p = 0.03 respectively).The donor's age and sex significantly affected the epithelial surface at D1 and for 2 weeks of KPT (p = 0.05, 0.04 and 0.005, 0.004 respectively).The cause of death affected the surface area at 2 weeks of the KPT (p = 0.05). TPD, TPU and TT also significantly impacted the corneal epithelium on D1 postoperative (p = 0.001, p = 0.05, p = 0.03 respectively). Without influence on the epithelium after this time.These abnormalities declined over time, and in some cases persisted after the 6th month. The majority of these epitheliopathies occurred in recipients over 45 years of age (76%).

Most of the risk factors for a defective epithelium cannot be controlled by the surgeon, however their prior knowledge helps in his treatment and this avoiding transplant rejection.The lack of graft’s epithelium integrity leads to a delay in visual rehabilitation, and therefore exposes the risk of serious infection, especially fungal one.