Elsevier

Ophthalmology

Volume 108, Issue 11, November 2001, Pages 2026-2028
Ophthalmology

Oversized corneal grafts for corneal opacities with iridocorneal adhesions

Presented in part as a poster at the annual meeting of the American Academy of Ophthalmology, Dallas, Texas, October 2000.
https://doi.org/10.1016/S0161-6420(01)00772-2Get rights and content

Abstract

Objective

To evaluate the efficacy of 1-mm oversized corneal grafts in patients with acquired corneal opacities and extensive peripheral iridocorneal adhesions.

Design

Prospective noncomparative case series.

Participants

Twenty patients (20 eyes) aged 15 years or older with unilateral or bilateral corneal opacification and a shallow anterior chamber.

Intervention

Penetrating keratoplasty was performed with donor corneal buttons oversized by 1 mm.

Main outcome measures

The various parameters evaluated were visual acuity, graft clarity, keratometry, anterior chamber depth, intraocular pressure, and spherical equivalent refraction 12 months after surgery.

Results

The keratoplasties were performed in 15 eyes with a corneo-iridic scar after infectious keratitis (75%) and 5 eyes with failed graft (25%). At the final follow-up, a clear graft was achieved in 17 eyes (85%), and 14 eyes (70%) achieved a best-corrected visual acuity of 6/12 or better. Three of the grafts failed because of rejection. The average keratometry was 44.1 ± 1.0 diopters (D), and the mean spherical equivalent was −3.23 ± 2.86 D. The oversized grafts provided a mean anterior chamber depth of 2.36 ± 0.42 mm, and the mean intraocular pressure at the 12 month follow-up was 16.38 ± 2.09 mmHg.

Conclusions

Corneal grafts oversized by 1 mm provide adequate anterior chamber depth and reduce the risk of peripheral anterior synechiae and secondary glaucoma in patients with corneal opacities and extensive peripheral iridocorneal adhesions.

Section snippets

Materials and methods

Twenty eyes of 20 patients, aged 15 years or older, were enrolled from the cornea service of our hospital. Eyes with corneo-iridic scars and failed grafts with flat or shallow anterior chambers with extensive PAS were included in this study. Eyes with posterior segment pathology, uncontrolled glaucoma (intraocular pressure [IOP] > 21 mmHg on one topical medication), and subnormal electrophysiologic tests (visual evoked potential and electroretinogram) were excluded.

Initial evaluation included a

Results

Of the 20 patients enrolled in our study, 14 were males and 6 were females, with a mean age of 46.8 ± 17.4 years (range, 15–75 years). The major indications for corneal grafting were corneo-iridic scar caused by infectious keratitis in 15 eyes (75%) and failed grafts in 5 eyes (25%). The donor trephination graft size was 8.5 mm in 16 eyes (80%) and 9.0 mm in 4 eyes (20%). Pupilloplasty and anterior segment reconstruction were required in 12 eyes, and goniosynechiolysis was performed in all of

Discussion

A corneal button oversized by 0.5 mm is traditionally used for corneal grafting in adults.3, 4, 5 Corneal opacification along with iridocorneal adhesions is one of the major indications for corneal grafting in this part of the world, and most of these cases have a shallow anterior chamber preoperatively.1, 2 It has been our experience that despite optimal suturing and synechiolysis, many patients with preexisting iridocorneal adhesions have a shallow anterior chamber, PAS, and raised IOP during

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