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E.M. Messmer, U.C. Welge–Lussen, A. Kampik; Anatomical and functional results after penetrating keratoplasty in mentally retarded patients . Invest. Ophthalmol. Vis. Sci. 2004;45(13):2916.
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Purpose: To retrospectively analyze outcome after penetrating keratoplasty (PK) in mentally retarded patients. Methods: PK was performed in 16 eyes of 13 patients with scarring keratoconus associated with Down's syndrome (6 pts.), perinatal asphyxia (6 pts.) and neonatal encephalitis (1 pt.) between 1999 and 2003. Surgeries included two re–PKs after transplant decompensation or rejection. The patients' mean age was 32 years (14–46 yrs.) with a male preponderance. Postoperative follow up ranged from 1 to 58 months (mean follow up 24 months). Pre– and postoperative visual acuity (VA), postoperative complications and their management were analyzed retrospectively. Statistics were performed using Mann–Whitney– and Wilcoxon Tests. Results: Mean preoperative VA was 20/800 (hand movements to 20/200). Surgery performed in general anesthesia was uneventful in all patients. Early postoperative complications included suture loosening (6 pts.), transplant rejection (4 pts.), anterior synechiae formation (3 pts.), corneal infiltration or ulceration (3 pts.) and secondary glaucoma (2 pts.). These complications necessitated additional surgery in 8/16 patients including replacement of loose corneal sutures (3 pts.), synechiolysis (2 pts.), temporal tarsorrhaphy (2 pts.), amnion membrane transplantation (1 pt.), cyclophotocoagulation (1 pt.) and re–KP (1 pt.). At the final visit 13 of 16 corneal transplants were clear. Postoperatively, VA improved significantly (p<0.001) and ranged from 20/600 to 20/30 (mean VA 20/100). In patients who experienced postoperative complications final VA was significantly lower than in patients with an uneventful postoperative course (p<0.01). Conclusions: Successful anatomical and functional PK is feasible in mentally retarded patients. However, the rate of early postoperative vision–threatening complications is high due to uncontrolled rubbing, lack of cooperation and late referral for therapy. Meticulous postsurgical care is therefore necessary in these patients. Non–penetrating surgical techniques such as deep lamellar keratoplasty may be advantageous in mentally handicapped patients to reduce postoperative complications.
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