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Elena Adjievska, Petja Vassileva, Nikolay Surchev, Tatyana Hergeldzhieva-Fileva; Corneal condition and anterior segment pathology in patients with bullous keratopathy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2571.
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To evaluate the corneal and anterior chamber condition in patients with bullous keratopathy who underwent penetrating keratoplaty (PK).
A retrospective review of clinical records of all consecutive patients with bullous keratopathy, referred for PK for the period January 2005 - December 2010, was performed. Preoperative status was analyzed with an emphasis on corneal condition and anterior segment abnormalities- presence and extent of corneal neovascularization, ocilar surface disorders, iris injuries with distorted pupil, anterior synechia and subluxated intraocular lens.
Bullous keratophaty was present in 54 of all 141 patients who underwent PK. Forty one of the patients had pseudophakic keratopathy, 6 pts were with aphakic and 3 with phakic keratopathy. One patient had graft failure, 1 pts- posttraumatic endothelial decompensation and in 2 of them Fuchs endothelial decompensation was found. Ocular surface abnormalities were diagnosed in 51 of the patients (94%) . In 30 of the cases (56%) deep and superficial corneal neovasclarization was observed. Other pathological findings included: painful epithelial bullae in 39cases (72%), subepithelial and stromal fibrosis in 18 patients (33%). In most patients all pathological sings were present but with different severity. Cornea was not neovascularizated and there was no fibrosis in only 5 cases. The ocular surface was not compromised in 3 of the patients. Another marker of advanced pathology was visual acuity: BCVA between 0,05 and 0,1 in 1 patient (2%), light perception to 0,05 in 26 pts (47%) and hand movement to light perceptiont in the rest of the pts.
The analysis of patients with bullous keratopathy demonstrated that advanced disease and severely affected corneal and anterior segment anatomy were present in all of the cases but with different severity. In all patients from our studied group the pathological changes excluded the option for lamellar grafting techniques, and PK remained the only treatment possibility. Main reasons for the accumulation of such a pool of challenging patients with delayed treatment are unreasonably prolonged conservative therapy of postoperative complications and lack of donor tissue. Addressing these issues could allow the use of lamellar grafting techniques, applicable only in the initial stages of bullous keratophaty. At present PK remains the main therapeutic option for our patient pool.
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