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Ajay Shalwala, Kristin M Hammersmith, Parveen Nagra, Christopher J Rapuano; Outcomes of Penetrating Keratoplasty in Iridocorneal Endothelial Syndrome. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2066.
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To evaluate outcomes of penetrating keratoplasty (PK) in iridocorneal endothelial (ICE) syndrome.
Charts of patients who underwent penetrating keratoplasty for ICE syndrome between January 2000 and March 2013 were reviewed. Glaucoma control, best corrected visual acuity pre- and post-PK, graft clarity, and graft rejection episodes were evaluated.
Twelve cases were reviewed with an average follow-up of 62 months after PK (range of follow up 6-159 months). Initial grafts failed in three patients (25%); in two cases, grafts rejected leading to failure, and in one case, failure was noted without evidence of rejection. Repeat grafting was performed in two of the three patients with graft failure. The remaining nine grafts remained clear through the end of follow up. At patients’ final visits, eleven grafts were clear. Intraocular pressure was controlled in all cases, with an average final visit IOP of 16 mmHg. Pre-PK, five patients were known to be using glaucoma medicines and four had known glaucoma surgery. At the end of the follow-up, eleven patients were using glaucoma medicines, and three patients required at least one glaucoma surgery after their initial PK. At the final follow-up visit, best corrected visual acuity (BCVA) in five patients (42%) was 20/40 or better. BCVA ranged from 20/50 to 20/100 in four patients (33%) and 20/200 to 20/400 in one patient (8%). Two patients (17%) had vision of counting fingers or worse (one due to failed graft and one due to severe glaucoma).
Clear grafts were achieved in all but one case, and only two patients had repeat PKs. Nearly half of the patients achieved best corrected visual acuity of 20/40 or better. Favorable outcomes can be achieved in patients with ICE syndrome, but best vision may require multiple corneal and glaucoma procedures.
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