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K. Hauer, D. Boehringer, P. Eberwein, H. Mittelviefhaus, T. Reinhard; Graft Survival of Penetrating Keratoplasty in Eyes With Insufficient Eyelid Closure Could Be Improved by Adequate Eyelid Surgery Prior to Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2009;50(13):596.
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We hypothesize on the basis of a multitude of case reports that graft survival of penetrating keratoplasty in eyes with insufficient eyelid closure may be substantially reduced. We additionally hypothesize that graft survival could be substantially improved by means of adequate eyelid surgery prior to keratoplasty. This is the first retrospective study dealing with this topic.
We reviewed the records of all 12 patients who underwent penetrating keratoplasty in eyes with insufficient eyelid closure. Only the first keratoplasty of each patient was included. Lid closure had been sufficiently corrected in five patients at time of keratoplasty (group A), whereas additional eyelid surgery was deemed necessary thereafter in the remaining seven patients (group B). Underlying diseases for insufficient eyelid closure were facial palsy and eyelid defects, evenly distributed between both groups. Age at keratoplasty averaged 61 and 64 years in groups A and B, respectively. Follow-up averaged 3 years. We compared clear graft survival of corneal grafts between group A and group B by means of Kaplan-Meier estimation and log-rank test.
All grafts failed in group B whereas all grafts remained clear in group A. Kaplan Meier estimation of graft survival three years postoperatively was 100% in group A and only 50% in group B. This difference, however, missed statistical significance (p=0.09).
Our retrospective investigation revealed a tendency towards improved graft survival upon eyelid repair prior to penetrating keratoplasty. Other prognostic parameters such as age at keratoplasty and cause of eyelid defect were evenly distributed between the two study groups. We thus suggest that adequate eyelid surgery should considered a prerequisite for penetrating keratoplasty.
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