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Paulo Rodolfo Tagliari Barbisan, Rosane Silvestre de Castro; Repeated Penetrating Corneal Transplantation in an University Hospital. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3150.
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To determine factors influencing penetrating corneal graft survival in patients undergoing tectonic transplants, receiving repeat grafts in the same eye after a failed first graft.
Retrospective review of patients undergoing repeat penetrating corneal transplantation, from November of 2008 to November of 2012. Comparative analysis of visual acuity, intraocular pressure and corneal transparency before surgery and after one year.
318 patients who underwent penetrating keratoplasty in the period from November of 2008 to November of 2012 were evaluated. Among the 318 transplants, the primary causes for the indication were: 199 (62.57%) Tectonic Transplantation, 65 (20.44%) Keratoconus, 23 (7.23%) Corneal Dystrophies, 17 (5.34%) Bullous Keratopathy and 14 (4.40%) Opacities / Scars. Of the 199 patients who underwent Tectonic Tranplantation, 36 were subjected to re-graft and regrafts were performed more than once in 2 eyes. The primary reasons to conduct a re-graft were Rejection [24 patiens (63.15%)], Primary Graft Failure [8 patiens (21.05%)] and Infection [6 patiens (15.78%)]. Analysis of the re-graft showed visual acuity improvement in 20 (52.63%), worsening in 8 (21.05%) and unchanged in 10 (26.31%); intraocular pressure improvement in 3 (7.89%), worsening in 3 (7.89%) and unchanged in 32 (84.21%); corneal transparency improvement in 25 (65.78%), worsening in 4 (10.52%) and unchanged in 9 (23.68%) patiens.
In a university hospital of reference there are high rates of tectonic transplants, since many patients are victims of trauma, corneal infection and corneal perforation. Thus, there is a higher rate of rejection, because the eyes have non-optimal conditions for a successful surgery (inflammation, infection, perforation), so it is more susceptible to regraft. Due to the urgency in which transplants are performed, there is also a high rate of primary failure, because the eye bank’s corneas used to perform the transplant, often are not optical corneas and of a poorer quality.
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