Abstract
Abstract: :
Purpose: Pre operative counselling for penetrating keratoplasty should include awareness of symptoms of possible complications as early presentation can enhance long term success. In our corneal transplantation service, all patients are instructed to arrange a same day emergency visit through a dedicated telephone line if they experience redness, sensitivity to light, vision loss, pain (R.S.V.P) or any other symptoms in eyes that have undergone keratoplasty. This study was designed to evaluate the reason for presentation, management outcome of each visit and the efficiency of the system in management of post keratoplasty complications. Methods: A prospective review of one hundred consecutive emergency visits by post penetrating keratoplasty patients was included. Results: Sixty-two patients from a cohort of 350, with a mean age of 62.8 years (range 18 ?92) presented between May 2001 and July 2002. 68% were male, with varied preoperative diagnosis. Sixteen visits were during the first month after surgery and forty visits within the first year. Ten patients (16%) sought consultation more than twice during the study period with one patient presenting 5 times. Pain and grittiness were the main presenting complaints (68%). Loose corneal suture (25%) necessitating removal was the most common diagnosis. Sixteen patients (26%) needed in-patient treatment. This group included graft rejection (13%), graft infection (8%), a case each of retinal detachment, increased intra ocular pressure and Bells palsy. Early intervention and successful management ensured graft survival and preservation of visual acuity in all our patients. Conclusions: Presentation with short duration of symptoms and gross reduction in postoperative visual acuity invariably indicate a serious complication. Most corneal surgeons educate their patient to seek prompt treatment for symptoms such as R.S.V.P as early intervention of any sight threatening complication increase the chance for graft survival and improvement of vision. This review shows a simple open access system helps early presentation and successful management of post graft complications.
Keywords: cornea: clinical science • transplantation • cornea: endothelium