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I. Dekaris, N. Gabri, D. Bosnar, . Karaman, A. Barii, J. Predovi; Corneal Graft Outcome After ,,Triple"Procedure . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1305.
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Combined perforative keratoplasty and extracapsular cataract surgery with intraocular lens implantation (triple procedure) has been performed with increasing success for patients with corneal disease and cataract since it's introduction in the mid–seventies. Group of authors report the indications, complications and outcomes of 63 triple procedures in our institute.
Prospective study of 63 consecutive cases of triple procedure performed by two experienced corneal surgeons between January 2000 and October 2004. was made. Relevant preoperative, operative and postoperative data are presented. Intraoperatively corneal recipient buttons were collected and IL–1 alpha level in their supernatant was measured by ELISA; while donor corneas unsuitable for clinical use served as controls. Outcome of the procedure was assessed by number of complications, graft survival rate and obtained best corrected visual acuity after at least one year of follow up.
Of 63 patients, 31 were man and 32 were woman with mean age 60.82 +/– 16 (range, 1–89). Reasons for keratoplasty were: corneal scarring with (20) or without vascularization (15), keratopathy (14), corneal dystrophy (5), rejected graft (4), bullous keratopathy (3), keratoconus (1) and keratoglobus (1). Intraoperative complications were: vitreous upthrust in 3 (4, 8%) cases and posterior capsule rupture in two (3, 2%) cases. In early postoperative period increased intraocular pressure was noticed in ten (23, 8%) cases, and primary graft failure in 2 cases (3, 2%). Late postoperative complications were: posterior capsular opacification in 14 (22, 2%), graft reaction in 19 (30%) and secondary glaucoma in 13 (20, 4%) cases. Follow up period was at least one year for each patient at which time 74% of the grafts remained clear. Mean postoperative visual acuity at last visit was 0, 37 +/– 0, 27. Measured IL–1 alpha level depended on preoperative diagnoses: corneal scar (5.50 +/– 3.10 pg/mm3), keratopathy (0.56 +/– 0.55 pg/mm3), corneal dystrophy (7.64 +/– 3.27 pg/mm3), rejected graft (4.45 +/– 2.06 pg/mm3), bullous keratopathy (3.65 +/– 2.33 pg/mm3), keratoconus (1.38 +/– 0.89 pg/mm3) and keratoglobus (3.61 +/– 0.65 pg/mm3). In all cases IL–1α production was significantly higher as compared to controls (0.69 +/– 0.36 pg/mm3) (p < 0.015).
Triple procedure including cataract extraction ,,via open sky" is recommended procedure for combined lens and corneal opacities. High level of IL–1 alpha in a recipient cornea at the time of surgery may stimulate corneal graft rejection.
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