Purchase this article with an account.
Catherine Croghan, Chi-Ying Chou, Sonul Gajree, Kanna Ramaesh, Deepa R Sivadasan Anijeet; Emergency therapeutic penetrating keratoplasties in a tertiary ophthalmic care facility. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5707.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate our experiences of emergency keratoplasty in a single tertiary ophthalmic care unit in West Scotland.
A retrospective case series is presented of 15 eyes in 14 patients who received therapeutic keratoplasty for corneal perforation or impending perforation, from January 2014 to October 2016. Anatomical success was defined by eradication of infection and/ or preservation of the globe. Corneal graft survival was defined by the presence of a clear graft at last follow up.
Mean age was 61(±14) years. Indications for emergency keratoplasty were infectious corneal melt which was unresponsive to medical management in 8 eyes, non-infectious immunological corneal melt in 5 eyes and trauma in 2 eyes. The follow up period was from 2 to 35 months. There was anatomical success in 14 of 15 eyes. Evisceration was required for one eye due to recurrent non- infectious corneal melt. The corneal graft survived in 9 of 15 eyes. 5 eyes underwent repeat keratoplasty.The corneal graft survival rate for those following trauma was 100% at 14 and 35 months follow up.The graft survival rate for infective corneal melt was 75%. 6 patients had clear grafts at follow up (mean follow up of 9 months). Post-operative complications included cataract in 2 patients and pupillary membrane in 1 patient. 1 graft failed at 2 months due to recurrent infectious corneal melt, 1 failed at 1 month due to rejection.In 5 patients with non- infectious corneal melt, 2 had Sjogrens syndrome, 1 had rheumatoid arteritis, 1 had Steven Johnston syndrome, and 1 had severe eczema. The survival rate in this group was 20%. 1 graft was clear at 2 month follow up. 2 grafts failed due to infectious corneal melt at 1 month and 9 months. 2 grafts failed due to non- infectious corneal melt, at 1 month and 11 months.
There is relative paucity of data in literature on emergency corneal transplants. A recent study found that half of the indications were for trauma. In this group infection was the major indication for an emergency keratoplasty followed by immunological melt. In spite of newer immunosuppressants, the outcome for immunological melt is dismal. Judicious use of pre, intra and postoperative antibiotic usage is crucial for graft survival in infectious aetiology. Larger multicentre studies are needed for better understanding variables affecting corneal graft outcome in an emergency context.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
This PDF is available to Subscribers Only