Indications and visual outcome following optical keratoplasty and their correlation with graft failure
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.
Keywords: optical keratoplastypenetrating keratoplastygraft rejectioncorneal scar
References
- Thylefors B, Négrel AD, Pararajasegaram R, et al. Global data on blindness. Bull World Health Organ. 1995; 73(1): 115–121.
- Dandona L, Dandona R, John RK. Estimation of blindness in India from 2000 through 2020: implications for the blindness control policy. Natl Med J India. 2001; 14(6): 327–334.
- Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol. 2012; 96(5): 614–618.
- Zare M, Javadi MA, Einollahi B, et al. Changing indications and surgical techniques for corneal transplantation between 2004 and 2009 at a tertiary referral center. Middle East Afr J Ophthalmol. 2012; 19(3): 323–329.
- Felipe AF, Hammersmith KM, Nottage JM, et al. Indications, visual outcome, and ectasia in clear corneal transplants 20 years old or more. Cornea. 2013; 32(5): 602–607.
- Williams KA, Lowe M, Bartlett C, et al. All Contributors. Risk factors for human corneal graft failure within the Australian corneal graft registry. Transplantation. 2008; 86(12): 1720–1724.
- Cosar CB, Sridhar MS, Cohen EJ, et al. Indications for penetrating keratoplasty and associated procedures, 1996-2000. Cornea. 2002; 21(2): 148–151.
- Siganos CS, Tsiklis NS, Miltsakakis DG, et al. Changing indications for penetrating keratoplasty in Greece, 1982-2006: a multicenter study. Cornea. 2010; 29(4): 372–374.
- Coster DJ, Williams KA. The impact of corneal allograft rejection on the long-term outcome of corneal transplantation. Am J Ophthalmol. 2005; 140(6): 1112–1122.
- Dandona L, Naduvilath TJ, Janarthanan M, et al. Survival analysis and visual outcome in a large series of corneal transplants in India. Br J Ophthalmol. 1997; 81(9): 726–731.
- Price MO, Thompson RW, Price FW. Risk factors for various causes of failure in initial corneal grafts. Arch Ophthalmol. 2003; 121(8): 1087–1092.
- Khadadoust AA. The allograft rejection reaction: The leading cause of late failure of clinical corneal grafts. In: Jones BR. ed. Corneal Graft Failure. Elsevier, New York 1973.
- Dandona L, Naduvilath TJ, Janarthanan M, et al. Survival analysis and visual outcome in a large series of corneal transplants in India. Br J Ophthalmol. 1997; 81(9): 726–731.
- Joshi SA, Jagdale SS, More PD, et al. Outcome of optical penetrating keratoplasties at a tertiary care eye institute in Western India. Indian J Ophthalmol. 2012; 60(1): 15–21.
- Muraine M, Sanchez C, Watt L, et al. Long-term results of penetrating keratoplasty. A 10-year-plus retrospective study. Graefes Arch Clin Exp Ophthalmol. 2003; 241(7): 571–576.
- Beckingsale P, Mavrikakis I, Al-Yousuf N, et al. Penetrating keratoplasty: outcomes from a corneal unit compared to national data. Br J Ophthalmol. 2006; 90(6): 728–731.
- Bhargava N. Healing of a graft in vascularized and non-vascularized corneal lesions. Indian J Ophthalmol. 1990; 38(4): 156–158.
- Mohan M, Panda A, Kumar TS. Results of penetrating keratoplasty in vascularized corneas. Ann Ophthalmol. 1990; 22(6): 235–238.
- Agrawal V, Vagh MM, Sangwan V, et al. Penetrating keratoplasty for pseudophakic bullous keratopathy. Indian J Ophthalmol. 1994; 42(2): 75–80.
- Srinivasan M, Rao GN, Aquavella JV. Corneal regrafting. Analysis of results. Indian J Ophthalmol. 1984; 32(5): 402–404.
- França ET, Arcieri ES, Arcieri RS, et al. A study of glaucoma after penetrating keratoplasty. Cornea. 2002; 21(3): 284–288.
- Huber KK, Maier AKB, Klamann MKJ, et al. Glaucoma in penetrating keratoplasty: risk factors, management and outcome. Graefes Arch Clin Exp Ophthalmol. 2013; 251(1): 105–116.
- Tixier J, Bourcier T, Borderie V, et al. [Infectious keratitis after penetrating keratoplasty]. J Fr Ophtalmol. 2001; 24(6): 597–602.
- Zheng YR, Sheng MJ. [Clinical observations on the combined operation of penetrating keratoplasty, extracapsular cataract extraction and IOL implantation]. Zhonghua Yan Ke Za Zhi. 1990; 26(3): 135–137.
- Jonas JB, Rank RM, Budde WM, et al. Factors influencing visual outcome after penetrating keratoplasty combined with intraocular lens implantation. Eur J Ophthalmol. 2003; 13(2): 134–138.