Assessment of the success rate of large size tectonic penetrating keratoplasty in severe necrotizing keratitis

Abstract EN

Some cases of severe necrotizing keratitis or corneal melting diseases, that fail to respond to all medical treatments, may be salvageable by an oversized or large diameter corneal graft.

In our study, the success rate of this procedure in the anatomic aspect [to maintain the integrity of the eye]and in the functional aspect [visual outcome]at the Khalili hospital, Shiraz is discussed.

Our procedure was done from September 2000 to August 2001 over the 13 eyes of 12 patients.

The size of the graft in all of these cases was larger than 11 mm.

Anatomical successes in our study was 84.7% [11 eyes saved, 2 eyes enucleated].

Visual improvement was seen in 7 eyes [54%]and useful vision [finger count acuity]remained only for 5 patients after one year.

Complications in our series were graft rejection in 9 cases [69.9%]; glucoma in 9 cases [69.9%]recurrent disease in 3 eyes [23%]; and secondary infection in 2 eyes [15.3%].

Despite its technical difficulties and high rate of complication after graft [due to the vicinity of limbal vessels, damage to the anterior chamber angle etc.], the procedure of limbus to limbus penetrating kertoplasty, in several cases can be an eye saving procedure, done in the late stages of corneal ulcers.

Despite its low success in attaining useful vision for the patient, it always serves this potential possibility to do a small optical graft over this tectonic graft and in a better situation