Transcript Indications and Outcome of Therapeutic Penetrating

Indications for and Outcomes of
Therapeutic Penetrating Keratoplasty
Sonika Gupta
Consultant Ophthalmology
Max Eye Care
New Delhi, India
Author has no financial interest
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
METHODS
Selection of cases
– Eyes with infective
keratitis had routine
diagnostic smear and
culture performed.
– Medical therapy was
the first line of
treatment.
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.
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.
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.
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.
Results
Indications for TPK in this study (also shown in piechart in next slide)–
• perforated corneal ulcer n=35
• non healing fungal keratitis n=35
• non healing bacterial keratitis n=21
• mixed infective keratitis n=7
• non healing viral keratitis n=2
• traumatic corneal perforation n=2
• chemical melt n=2
Main Indications for TPK
perforated
corneal ulcer
2%
90
80
70
60
50
40
30
20
10
0
2%
7%
non healing
fungal keratitis
2%
20%
33%
34%
East
non healing
bacterial West
keratitis North
mixed infective
keratitis
non healing
2nd Qtr 3rd Qtr 4th Qtr
viral keratitis
traumatic
Outcome of TPK
• Anatomical integrity
was achieved in 101
eyes (97.1%).
• 3 eyes were phthisical.
• Clear grafts seen in 42
eyes (40.3%)
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%.
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.