Posters

Facing the challenges in keratoplasty, managing complex situations

Poster Details

First Author: K. Mahmood PAKISTAN

Co Author(s):                        

Abstract Details

Purpose:

Penetrating Keratoplasty is a very useful treatment modality for visual rehabilitation in patients suffering from deep corneal scar. Difficult situations arise when corneal scarring is associated with cataract, adherent leucoma, post retinal surgery, severe pannus and impending perforation. In such cases we have to modify the surgical techniques and combine the PKP with different maneuvers like cataract extraction with or without IOL implantation, leucomectomy, pupilloplasty, silicone oil removal and Anti-VEGFs. The purpose of the study was to assess visual outcome and complications in additional procedures to penetrating keratoplasty.

Setting:

Aadil Hospital DHA ,Lahore and Medicare Eye Centre Lahore

Methods:

70 eyes operated for PK and additional procedures over the period of last 2.5 years with average follow up of 13 months. Different situation were faced including posterior synechiea, atrophic iridis, adherent leucoma and PC rupture. In 51 eyes IOL was implanted after open sky cataract extraction, Leucomectomy and pupilloplasty in 12, anterior vitrectomy in 5, scleral fixation IOL in 4, silicone oil removal in 02 and in 1 eye cataract extraction was done without IOL implantation. Anti-VEGF subconjunctival given in eyes with severe vascularization in 08 eyes. The pre-op VA ranged from HM to CF. B-Scan and UBM done.

Results:

The post-op period showed excellent visual recovery. The VA improved from projection of light to 6/60 in 12 cases. 49 eyes ranged between 6/36 and 6/18 after correction and selective suture removal. In 06 eyes the BCVA was 6/12. Complications included endothelial failure in 3 cases, posterior synechiae, shallow AC and secondary glaucoma. The cases of CCC and in the bag placement of IOL showed more IOL stability. IV mannitol and dry vitrectomy is more helpful in selected cases to stabilize the IOL positioning.

Conclusions:

Visual outcome was very satisfactory. Penetrating keratoplasty and cataract extraction with IOL is a better surgical approach in eyes having scarred corneas complicated with cataracts. IOL implantation in primary surgery has got very good visual outcome and has few postoperative complications. The TRIPLE procedure including CE +IOL via open sky is the method of choice for combined lens and corneal opacities.Because of the often rapidly progressive nuclear cataracts after PK, I recommend simultaneous approach even with incipient lens opacities.

Financial Disclosure:

NONE