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W. Chen, G. Li, L. Sun, H. Ma, Q. Wang, J. Qu; Optical Full–Thickness Lamellar Keratoplasty for Fungal Keratitis Using Cryopreserved Donor Corneas . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3569.
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Fungal keratitis is responsible for a significant burden of blinding disease in the developing world. Since some severe complications occurred in penetrating keratoplasty and recurrence or poor visual outcome after partial lamellar keratoplasty, current treatment methods frequently fail to preserve or restore vision after fungal keratitis. Our purpose was to investigate whether optical full–thickness lamellar keratoplasty with cryopreserved donor corneas could be used to eradicate the infection, obviate complications, and restore vision in the treatment of fungal keratitis not curable by antifungal chemotherapy.
Full–thickness LKP was performed in fifteen eyes of 15 patients with fungal keratitis confirmed by microscopic analysis of corneal scrapings or confocal microscopy, and not cured by antifungal chemotherapy. Surgical procedures included deep removal of corneal stroma with the use of a very fine forceps tip and a fine blunt spatula, exposing Descemet membrane in the entire stromal bed, and grafting a cryopreserved donor corneal button without Descemet’s membrane and endothelium. The excised recipient lamella was used for microbial culture and histopathologic examination. After surgery, topical antifungal treatment was continued for 2 weeks with gradual tapering of the drugs. Visual acuity, corneal clarity, and endothelium cell density were assessed at different time points after surgery.
During surgery, no case occurred intraoperative perforation of Descemet membrane. Full corneal epithelialization was achieved in 8 eyes (53.3%) within 7 days and in 13 eyes (86.7%) within 10 days after surgery. Delayed epithelial healing occurred in one eye (6.7%). Patient follow–up ranged from 7 to 20 months. Among these 15 eyes, only one eye (6.7%) occurred recurrence of the fungal infection within 2 weeks. Histopathologic analysis of PAS–stained tissue sections of donor lamellae revealed fungal filaments in all samples. The resulting best–corrected visual acuity ranged from 20/40 to 20/20. Overall, mean post–operative endothelium cell density was 2367 cells/mm2 (range 1025–3491 cells/mm2). Immune reactions to the lamellar grafts were not observed and the donor lamellae remained clear for the duration of follow–up.
Our findings suggest that Optical full–thickness Lamellar keratoplasty using cryopreserved donor corneas for the treatment of fungal keratitis is a safe and effective method of restoring visual acuity, but recurrence remains a risk and the indication of full–thickness LKP for fungal keratitis need to be further studied.
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