Purchase this article with an account.
F. Ferrario, S. Matuska, G. Paganoni, A. Spinelli, C. Insacco, M. Viganò, P. Rama; Penetrating Keratoplasty After Cultivated Limbal Stem Cell Transplantation. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1790.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To describe the outcome of penetrating keratoplasty (PKP) in patients who had previously undergone cultivated limbal stem cell transplantation.
Medical records of patients with limbal stem cell deficiency who underwent PKP after cultivated limbal stem cell transplantation were reviewed for demographics, primary etiology, type of surgical procedure, best corrected visual acuity, ocular surface conditions and complications.
Thirty-eight patients with limbal stem cell deficiency underwent PKP at a mean interval of 23.5 months (range: 6-92 months) following cultivated limbal stem cell transplantation. Twenty-one patients (55.3%) underwent PKP, 17 patients (44.7%) PKP combined with cataract extraction. Preoperative best-corrected visual acuity was less than 1/10 in 29 of the 38 eyes (76.3%). At a mean follow-up of 27.5 months (range: 1-92 months) after PKP, the best-corrected visual acuity improved in 33 patients (86.8%), worsened in 3 (7.9%) and remained unchanged in 2 (5.3%). PKP after limbal stem cell transplantation was successful with a clear central cornea in 34 eyes (89.5%) and failed in 4 eyes (10.5%): we observed one primary graft failure and three secondary graft failures, after rejection in one case, after vitreoretinal surgery with silicone oil injection in another case, and due to persistent inflammation in the third case. We observed blepharitis in 21 patients, with moderate or severe ocular inflammation in 14 cases. Three patients had delayed epithelial healing. Seventeen of the 38 eyes suffered corneal rejection episodes, 16 of them responded favourably to treatment. Thirteen eyes experienced epithelial defect, one of which was herpetic PCR-positive. Eleven patients had intraocular hypertension, successfully controlled with topical therapy. Six patients experienced suture loosening.
The results of PKP after limbal stem cell transplantation are favourable in terms of visual acuity and corneal transparency. Rejection episodes are more common than in low-risk PKP. Inflammation and blepharitis are frequent and influence the final outcome.
This PDF is available to Subscribers Only