Vol 6 (2021): Continuous Publishing
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Published online: 2021-11-26

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Indications and visual outcome following optical keratoplasty and their correlation with graft failure

Nasrin Y1, Rashmi Rath1
Ophthalmol J 2021;6:184-192.

Abstract

Background: The aim was to study the indications for optical keratoplasty and its correlation with risk factors, postoperative course, and graft survival outcome.

Material and methods: A non-randomized prospective interventional descriptive study was carried out on 71 eyes of 71 patients aged between 15 to 75 years undergoing optical keratoplasty. Surgical procedures such as penetrating keratoplasty (PK), PK + posterior-chamber intraocular lens implantation (PCIOL), PK + the absence of the lense of the eye (aphakia), and PK + anterior vitrectomy were performed in 34, 28, 6, and 2 cases, respectively. Indications and outcomes were measured by graft survival and visual acuity. The survival rate of grafts and their correlation with variables such as corneal vascularization, previously failed grafts, history of infection, post-perforation corneal scars, graft size, type of surgery, and follow-up were assessed.

Results: The most common indication was the corneal scar, measured high in agriculture laborers. There was a significant correlation observed between prognosis and graft survival (p < 0.001). The success rate for corneal scars was around 75%. At 6-months follow-up the complication observed was failed graft (n = 7). This is due to preoperative indication in these cases were corneal scar (n = 3), post-therapeutic PK (n = 2), adherent leucomas (n = 1), and keratoconus (n = 1). The common cause of graft failure was fungal graft infection (n = 4). Out of 6 eyes that had graft infection, 4 underwent repeat graft (PK + PCIOL). Twenty-eight eyes underwent PK + PCIOL implantation surgery resulting in good visual acuity (p < 0.001). 66% of patients achieved a best corrected visual acuity (BCVA) of 6/36 or better. Patients who underwent PK + PCIOL procedure achieved a good visual outcome. The trephination of the diseased cornea of 7.5 mm/8 mm graft of size allowed to achieve a good visual outcome.

Conclusion: The success rate in corneal scars was around 75%. Graft failure seen at 6-months post-operative follow-up was mostly associated with graft infection and repeat graft (PK + PCIOL). PK + PCIOL procedure and 7.5 mm/8 mm graft of size achieved a good visual outcome. Recognition and management of complications and graft rejection early are crucial for long-term graft survival and satisfactory visual outcome.

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