Corneal Graft Recovery Following Penetrating Keratoplasty
Corneal Graft Recovery Following Penetrating Keratoplasty
The patient demographics are shown in Table 1. The topical steroid that had been administered before rejection to prevent rejection was dexamethasone phosphate 0.1% in 25 cases, fluorometholone 0.1% in 19 cases and cyclosporine 0.1% in two cases. No steroid treatment had been administered before rejection in nine cases, including seven cases at a physician's direction several years after surgery and two eyes against a physician's recommendation. No data were available in three additional cases. The factor triggering rejection was related to broken sutures in five cases and self-discontinuation of topical steroid treatment in two cases. The mean interval between PKP and corneal graft rejection was 31.5 ± 36.7 months and that between corneal graft rejection and the administration of systemic steroids was 9.2 ± 9.7 days. All patients were treated for corneal graft rejection with above protocol, which is started with dexamethasone phosphate 0.1% eye drop and systemic steroids. The mean average follow-up after corneal graft rejection was 19.8 ± 12.7 months.
The mean best-corrected visual acuity (Log MAR) was 0.66 ± 0.75 before corneal graft rejection, 1.33 ± 0.87 before treating the corneal graft rejection and 1.03 ± 1.04 after treatment. Data on the ECD before rejection were obtained in 29 eyes (50.0%). In 18 of these eyes, data on the ECD after rejection were also obtained. The ECD in 18 eyes was 1556 ± 840 cells/mm before rejection versus 772 ± 464 cells/mm after rejection (P < 0.001). Graft transparency was restored in 37 of 58 eyes (63.8%). Nineteen of 41 cases that were observed for more than 1 year after rejection had a clear graft at 1 year and 4 of 7 cases that were observed for more than 3 years after rejection had a clear graft at 3 years. Graft clarity was maintained in 25 of 37 eyes (observation period, 20.7 ± 14.4 months), with corneal decompensation occurring 6.0 ± 4.3 months after the recovery of transparency in the remainder.
Groups 1 and 2 are compared in Table 2. The interval between rejection and treatment was shorter in Group 1 (OR, 0.88, 95% CI, 0.80–0.97, P = 0.093). No differences were observed in age, sex, diagnosis before PKP, type of surgery, history of glaucoma, previous episodes of rejection, ECD before rejection, interval between PKP and rejection or treatment method.
Groups 1A and 1B are compared in Table 3. Regarding the diagnosis before PKP, regraft was less prevalent in Group 1A (OR, 0.09, 95% CI, 0.01–0.54, P = 0.091). No differences were observed in age, sex, type of surgery, history of glaucoma, previous rejection episodes, ECD before rejection, interval between rejection and treatment, treatment or interval between treatment and recovery of transparency.
The side effects of topical and systemic steroids are shown in Table 1. Increased intraocular pressure (IOP), which was controlled with additional medication, was detected in 15 of 58 eyes (25.9%). Seven of the 15 patients had pre-existing glaucoma. Corneal infection developed within 3 months in 4 of 58 eyes (6.9%), including three cases of recurrent herpes simplex keratitis and one of fungal keratitis. No severe systemic side effects were observed and intravenous steroid administration was completed according to the protocol in all cases.
Results
Demographics and Clinical Features
The patient demographics are shown in Table 1. The topical steroid that had been administered before rejection to prevent rejection was dexamethasone phosphate 0.1% in 25 cases, fluorometholone 0.1% in 19 cases and cyclosporine 0.1% in two cases. No steroid treatment had been administered before rejection in nine cases, including seven cases at a physician's direction several years after surgery and two eyes against a physician's recommendation. No data were available in three additional cases. The factor triggering rejection was related to broken sutures in five cases and self-discontinuation of topical steroid treatment in two cases. The mean interval between PKP and corneal graft rejection was 31.5 ± 36.7 months and that between corneal graft rejection and the administration of systemic steroids was 9.2 ± 9.7 days. All patients were treated for corneal graft rejection with above protocol, which is started with dexamethasone phosphate 0.1% eye drop and systemic steroids. The mean average follow-up after corneal graft rejection was 19.8 ± 12.7 months.
Outcome of Steroid Treatment
The mean best-corrected visual acuity (Log MAR) was 0.66 ± 0.75 before corneal graft rejection, 1.33 ± 0.87 before treating the corneal graft rejection and 1.03 ± 1.04 after treatment. Data on the ECD before rejection were obtained in 29 eyes (50.0%). In 18 of these eyes, data on the ECD after rejection were also obtained. The ECD in 18 eyes was 1556 ± 840 cells/mm before rejection versus 772 ± 464 cells/mm after rejection (P < 0.001). Graft transparency was restored in 37 of 58 eyes (63.8%). Nineteen of 41 cases that were observed for more than 1 year after rejection had a clear graft at 1 year and 4 of 7 cases that were observed for more than 3 years after rejection had a clear graft at 3 years. Graft clarity was maintained in 25 of 37 eyes (observation period, 20.7 ± 14.4 months), with corneal decompensation occurring 6.0 ± 4.3 months after the recovery of transparency in the remainder.
Prognostic Factors
Groups 1 and 2 are compared in Table 2. The interval between rejection and treatment was shorter in Group 1 (OR, 0.88, 95% CI, 0.80–0.97, P = 0.093). No differences were observed in age, sex, diagnosis before PKP, type of surgery, history of glaucoma, previous episodes of rejection, ECD before rejection, interval between PKP and rejection or treatment method.
Groups 1A and 1B are compared in Table 3. Regarding the diagnosis before PKP, regraft was less prevalent in Group 1A (OR, 0.09, 95% CI, 0.01–0.54, P = 0.091). No differences were observed in age, sex, type of surgery, history of glaucoma, previous rejection episodes, ECD before rejection, interval between rejection and treatment, treatment or interval between treatment and recovery of transparency.
Side Effects of Steroids
The side effects of topical and systemic steroids are shown in Table 1. Increased intraocular pressure (IOP), which was controlled with additional medication, was detected in 15 of 58 eyes (25.9%). Seven of the 15 patients had pre-existing glaucoma. Corneal infection developed within 3 months in 4 of 58 eyes (6.9%), including three cases of recurrent herpes simplex keratitis and one of fungal keratitis. No severe systemic side effects were observed and intravenous steroid administration was completed according to the protocol in all cases.
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