Large Diameter Lamellar Keratoplasty With And Without Endothelial Transplantation Significantly Improves Long Term Survival Of Grafts Performed In Eyes With Herpetic Scars

Published 2022 - 40th Congress of the ESCRS

Reference: FPT06.02 | Type: Free paper | DOI: 10.82333/39hm-fk15

Authors: Ginevra Giovanna Adamo* ¹ , Angeli Christy Yu ² , Fiorella Fusco ² , Rossella Spena ² , Cristina Bovone ² , Massimo Busin ²

¹Department of Translational Medicine,University of Ferrara,Ferrara ,Italy;Department of Ophthalmology,Ospedali Privati Forlì "Villa Igea",Forlì,Italy, ²Department of Translational Medicine,University of Ferrara,Ferrara,Italy;Department of Ophthalmology,Ospedali Privati Forlì "Villa Igea",Forlì,Italy

Purpose

To evaluate the outcomes of lamellar keratoplasty with and without endothelial transplantation for the treatment of eyes with high-risk vascularized herpetic corneal scars.

Setting

Tertiary Eye Care Referral Center (Ospedali Privati Forlì “Villa Igea”, Forlì, Italy).

Methods

This prospective interventional case series evaluated the outcomes of consecutive eyes that underwent keratoplasty for herpetic corneal scars in the presence of otherwise healthy endothelium. Deep anterior lamellar keratoplasty (DALK) was attempted in 120 eyes, of which 22 required a conversion to 2-piece mushroom keratoplasty (MK). Main outcome measures were best spectacle-corrected visual acuity (BSCVA), refractive astigmatism (RA), endothelial cell density (ECD), as well as immunologic rejection, herpetic recurrence, and graft failure rates.

Results

Average BCVA at 5 years was 0.10±0.12 in the DALK group and 0.09 ± 0.15 in the MK group (p = 0.75). Five-year ECD was significantly higher in the DALK group than in the MK group (DALK: 1826.36 ± 466 cells/mm2, MK: 1162 ± 274 cells/mm2; P < 0.001). Mean refractive astigmatism after complete suture removal was 2.8±1.4 D in the DALK group and 3.0±1.7 D in the MK group. The five-year cumulative risk for immunologic rejection (DALK: 3%, MK: 6%, p = 0.38), herpetic recurrence (DALK: 6%, MK: 9%, p=0.38), and graft failure (DALK: 4%, MK: 5%, p=0.75) was comparable in both groups.

Conclusions

Large diameter lamellar keratoplasty achieves satisfactory visual outcomes that remain stable beyond 5 years after surgery with minimal risk of immunologic rejection, herpetic recurrence and graft failure. Excellent clinical outcomes associated with a 2-piece MK in cases converted from intended DALK support the use of large-diameter DALK (9 mm) as a feasible and practical primary surgical approach for vascularized herpetic scars.