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Denise Loya, Lucero Pedro Aguilar, Arturo J Ramirez-Miranda, Alejandro Navas, Alejandro Lichtinger, Aida Jimenez-Corona, Enrique O Graue; OUTCOMES OF SCLERO-CORNEAL KERATOPLASTY IN SEVERE CORNEAL PERFORATIONS. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1552.
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© ARVO (1962-2015); The Authors (2016-present)
To describe visual outcomes and prognosis after sclero-corneal keratoplasty (SCK) in severely perforated eyes.
Retrospective review of clinical records of 29 patients who underwent sclero-corneal grafts for perforating lesions over a period of 13 years was performed. Information about the studied variables included demographics characteristics, medical history, surgical indications, clinical course, complications, visual outcomes and ocular integrity were analyzed. Analyses were done using Stata 13.<br /> <br /> <br /> <br /> <br />
We included 25 eyes from 25 patients (12 men and 13 women), with a mean age of 50.6 ± 17.4 years. The median follow-up of the patients was 10 months. The main causes of perforation were rheumatoid corneal melt, infectious keratitis, Wegener's granulomatosis, Sjögren's syndrome, pemphigus, trauma and chemical injury. The mean preoperative best-corrected visual acuity was 2.9 ±1.3 logMAR. Postoperatively, the visual acuity only improved in 3 eyes (11.11%). The most commonly reported complications were: persistent epithelial defect in 28 %, choroidal detachment in 16%, ocular hypertension in 24%, Seidel in 16%, synechiae 16% and retinal detachment in 8%. Evisceration was required in 25% of the cases. In multiple logistic regression analysis, the main predictors associated with complications after SCK included patients pretreated with amniotic membrane transplantation or therapeutic keratoplasty (odds ratio13.8, p=0.035) and autoimmune disease background (odds ratio 10.4, p=0.06).
Sclero-corneal keratoplasty in autoimmune diseases and corneal perforations pretreated with amniotic membrane transplantation or therapeutic keratoplasty were associated to higher risk of complications and worse prognosis after this procedure. While sclero-corneal keratoplasty visual outcomes could be unfortunate, psychological benefits of retaining the eyeball can be obtained, as well as preserving ocular motility and avoiding enophthalmos, even in an apparently futile scenario.
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