Please use this identifier to cite or link to this item: doi:10.22028/D291-35366
Title: An attempt to optimize the outcome of penetrating keratoplasty in congenital aniridia-associated keratopathy (AAK)
Author(s): Farah, C. J.
Fries, F. N.
Latta, L.
Käsmann-Kellner, B.
Seitz, B.
Language: English
Title: International Ophthalmology
Volume: 41
Issue: 12
Pages: 4091–4098
Publisher/Platform: Springer Nature
Year of Publication: 2021
Free key words: Aniridia-associated keratopathy
Penetrating keratoplasty
Limbal stem cell deficiency
Amnion membrane transplantation
Autologous serum
DDC notations: 610 Medicine and health
Publikation type: Journal Article
Abstract: Purpose To propose an optimized microsurgical and medical approach to reduce the risk of complications after penetrating keratoplasty (PKP) in patients with aniridia-associated keratopathy (AAK). Methods Retrospective observational case series of 25 PKP performed in 16 patients with AAK. Preoperative indications were endothelial decompensation and vascularized scars (68%) or graft failure (32%) due to limbal stem cell deficiency. The optimized approach included a combination of a small corneal graft size (around 7.0 mm), interrupted 10–0nylon sutures, simultaneous AMT as a patch, large bandage contact lens, temporary lateral tarsorrhaphy, postoperative autologous serum eye drops, and systemic immunosuppression. Main outcome measures included: visual acuity, transplant survival, and complications encountered during follow-up of 107 weeks on average. Results A complete modified keratoplasty scheme was used in 10 of 25 PKP (group 1), while at least one of the modifications was missing in the other 15 PKP (group 2). After 8 weeks of follow-up, the epithelium was closed in 23 eyes. Visual acuity improved in 19 eyes at 6 months of follow-up, and remained stable in six eyes. None of the eyes showed a decrease in visual acuity. At the last post-operative follow-up, this visual improvement persisted in 14 eyes and graft survival rate after 156 weeks (3 years) was 69% in group 1 versus 44% in group 2 (p = 0.39, log-rank test). Secondary corneal neovascularization (8%), scarring (4%), ulcer (4%), or graft rejection (8%) happened mostly in the second group which was missing at least one of the suggested modifications. Conclusions PKP in congenital aniridia must be considered as a high-risk keratoplasty. An optimized therapeutic approach seems to be promising in order to reduce the postoperative complication rate in these most difficult eyes.
DOI of the first publication: 10.1007/s10792-021-01982-z
Link to this record: urn:nbn:de:bsz:291--ds-353667
ISSN: 1573-2630
Date of registration: 1-Feb-2022
Faculty: M - Medizinische Fakultät
Department: M - Augenheilkunde
Professorship: M - Prof. Dr. Berthold Seitz
Collections:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

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