Indications for and Outcomes of Therapeutic Penetrating Keratoplasty

1
Indications for and Outcomes of Therapeutic
Penetrating Keratoplasty

• Sonika Gupta
• Consultant Ophthalmology
• Max Eye Care
• New Delhi, India
• Author has no financial interest

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Purpose /Methods

• To evaluate the indications and outcome of
  Therapeutic Penetrating Keratoplasty (TPK).
• Retrospective review of records of 104
  consecutive patients (104 eyes) who underwent TPK
  was carried out.
• Review included age, gender, indication for
  surgery, surgical details, post-operative
  complications, visual and anatomical outcome of
  surgery

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METHODS

• Selection of cases
• Eyes with infective keratitis had routine
  diagnostic smear and culture performed.
• Medical therapy was the first line of treatment.

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Methods

• Indications for TPK were
• Corneal ulcer refractory to maximal medical
  therapy
• Perforation more than 3mm
• Descemetocele with infiltrates
• Regrafts were not included in the study.

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Methods- Surgical procedure

• Donor corneas were obtained from the
  corneoscleral button preserved in McCarey Kaufman
  culture medium.
• The donor button was oversized by 0.5mm and
  punched from endothelial side of the
  corneoscleral button.
• Host trephine size was selected to cover the
  infiltrate edge of the ulcer completely.
• The anterior chamber was irrigated to remove any
  inflammatory debris.

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Methods- Surgical details

• Viscodissection of the angle was done to ensure
  thorough cleaning of the anterior chamber of any
  exudate and release any peripheral anterior
  synechiae.
• Cataract, if present was not disturbed unless
  lens was found subluxated.
• In eyes with aphakia or vitreous loss, anterior
  vitrectomy was done
• The donor button was sutured to the host with 16
  interrupted 10-0 monofilament nylon suture bites.
• Suture knots were trimmed and buried towards the
  donor side.

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RESULTS

• Total no. of patients 104 (104 eyes).
• Mean age of patients 45.78 18.68 years
• 81 males (77.8) 23 females (22.1).
• Mean follow up 18 months.

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Results

• Indications for TPK in this study (also shown in
  pie-chart in next slide)
• perforated corneal ulcer n35
• non healing fungal keratitis n35
• non healing bacterial keratitis n21
• mixed infective keratitis n7
• non healing viral keratitis n2
• traumatic corneal perforation n2
• chemical melt n2

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Main Indications for TPK
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Outcome of TPK

• Anatomical integrity was achieved in 101 eyes
  (97.1).
• 3 eyes were phthisical.
• Clear grafts seen in 42 eyes (40.3)

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Results

• Post op vision remained the same in 64 eyes
  (62.4)
• 16.3 eyes had vision 20/200
• Causes of graft failure were ocular surface
  disease 25.0 , graft infection 16.3, glaucoma
  7.69 , graft rejection 5.76
• and primary graft failure 4.80.

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CONCLUSION

• TPK is successful in maintaining the anatomical
  integrity of the eye.
• TPK has an important role in salvaging the eyes
  with active uncontrolled infection or perforation
  from corneal disease.
• Lower number of clear grafts in our study could
  be due to delay in presentation by the patient
  leading to delayed surgical intervention, lack
  of availability of good quality donor tissue and
  inadequate compliance with follow-up.