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Fabian Norbert Fries, Christian Farah, Lorenz Latta, Barbara Käsmann-Kellner, Berthold Seitz; Small graft, simultaneous amniotic membrane transplantation, temporary lateral tarsorrhaphy and autologous serum improves outcome of penetrating keratoplasty in congenital aniridia with aniridia associated keratopathy. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6311.
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© ARVO (1962-2015); The Authors (2016-present)
Aniridia associated keratopathy (AAK) leads to corneal opacities, scarring and vascularisation due to a unique form of limbal stem cell deficiency. Persisting epithelial defects, suture loosening and an increased risk of graft rejection are typical postoperative complications in high risk keratoplasty (KP) such as in congenital aniridia. We hypothesized that the combination of a small corneal graft size, interrupted sutures, simultaneous amniotic membrane transplantation (AMT) as a patch, large bandage contact lens (BCL), temporary lateral tarsorrhaphy, postoperative autologous serum eye drops (SED), and systemic immunosuppression can reduce the risk of those complications.
Between 2012 and 2018, twenty PK were performed in 13 patients with congenital aniridia at our Department of Ophthalmology – in 2 eyes as a triple procedure. Morphological and functional status during follow-up were analyzed retrospectively.
Six KP were performed using continuous double running suture, 14 using interrupted sutures. AMT with a 17mm BCL was applied 18 times to promote postoperative corneal wound healing. In 10 cases, a simultaneous temporary lateral tarsorrhaphy was performed to support corneal wound closure.At 6 weeks follow-up, the epithelium was closed in 19 eyes, only one patient needed a second AMT due to persisting epithelial defect. 18 eyes received postoperative SED. All patients received systemic immunosuppression (Ciclosporin or Mycophenolat mofetile). Visual acuity improved in 14 eyes at 6 months follow-up, in 6 eyes visual acuity remained stable, no eye showed a decrease in visual acuity. While the ten eyes that received the complete modified KP scheme showed no epithelial defect at 6 weeks follow-up and had no corneal complications until one year postoperatively, persistent epithelial defect, graft rejection or suture insufficiency happened exclusively to the other half that was missing at least one of the suggested modifications (p< 0.05).
A modified KP scheme combining a small corneal graft size, interrupted sutures, simultaneous AMT, large BCL, temporary lateral tarsorrhaphy, postoperative autologous SED, and systemic immunosuppression seems to be appropriate to reduce the postoperative complication rate in these most difficult eyes.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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