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H Spelsberg, T Reinhard, R Sundmacher; Homologeous Penetrating Central Limbo-keratoplasty in Granular and Lattice Corneal Dystrophy: Longterm Follow-up . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4176.
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Purpose: To update the clinical follow-up of patients with granular and lattice dystrophy after homologeous penetrating central limbo-keratoplasty (LKP), which was developed in order to avoid or reduce recurrences of the dystrophy in the corneal grafts. Methods: In 17 eyes from 15 patients with lattice and in 16 eyes from 13 patients with granular dystrophy LKP was performed since mai 1995. All patients but two were treated with systemic immunosuppression like ciclosporin A (21 eyes) or mycophenolate mofetile (10 eyes) for six months postoperatively. Longterm topical immune prophylaxis with two drops prednisolone-21-acetate 1% per day was administered in all patients. The results were compared to a historic control group (conventional penetrating keratoplasty, KP) of 20 patients with granular and 16 patients with lattice dystrophy. Results: Up to now, five recurrences of granular dystrophy (5/16) and one recurrrence of lattice dystrophy (1/17) were observed after LKP. The recurrence ratio was 41% in granular and 0% in lattice dystrophy estimated according to Kaplan and Meier within four years postoperatively. In KP eyes, respectively, the recurrence ratio was 80% in granular and 16% in lattice dystrophy. These differences between LKP and KP were not statistically significant (p=0.16; log-rank-test), whereas after a follow-up period of only three years there had been a statistically significant difference (p=0.05). Conclusion: In the first three postoperative years LKP was associated with significantly less recurrences in granular and lattice dystrophy in comparison to KP. In the medium run, however, this difference is no longer statistically significant. The possible explanation is the gradual disappearance of the transplanted stem cells by time. The crucial challenge, therefore, will be to ensure longterm survival of limbal stem cells.
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