ABSTRACT
To investigate indications and methods of surgery in corneal transplantation in Labbafinejad medical center from 2007 to 2009. Records of 1083 patients who had undergone corneal transplantation from 2007 to 2009 were reviewed. Age, sex and indication and type of surgery were evaluated. Patients included 709 [65.5%] male and 374 [34.5%] female subjects with mean age of 43.2 +/- 10.2 year [range, 17 days to 33 years] keratoconus [36.7%] was the most common indication followed by cataract extraction with or without IOL insertion [12.8%]; corneal ulcers due to bacterial, fungal and acanthamoba infections [11.7%]; non herpetic scar and opacities [7.4%]; trachoma keratopathy [5.6%]; corneal dystrophy [4.6%] and mustard gas keratopathy [4%]. The most common type of surgery was penetrating keratoplasty [56.2%] followed by deep anterior lamellar keratoplasty [24.5], tectonic grafts [9.4%], lamellar keratoplasty [3.4%], endothelial graft [3.5%] and keratolimbal allograft without penetrating keratoplasty [3.1%]. During this 3 years period, keratoconus was still the most common indication for corneal transplantation but rate of regraft is increasing in comparison with previous reports. Corneal edema following cataract surgery with or without intraocular lens implantation was the second most common indication. Rate of endothelial grafts and keratolimbal alografts have increased since our previous reports
ABSTRACT
To report the outcomes of conjunctival-limbal autograft [CLAU] in patients with unilateral total limbal stem cell deficiency [LSCD] emphasizing surgical problems, complications, and their management. In this prospective interventional case series, CLAU combined with amniotic membrane transplantation as a graft was performed on 26 patients with unilateral total LSCD due to chemical or thermal injuries. Penetrating keratoplasty [PKP] was performed on eyes with dense corneal opacification. Main outcome measures were visual acuity, corneal transparency and vascularization, and complications. Optical PKP was performed on 18 eyes. Best spectacle-corrected visual acuity [BCVA] was 2.28 +/- 0.45 LogMAR before CLAU which improved to 0.64 +/- 0.52 LogMAR and 0.35 +/- 0.13 LogMAR at final follow-up in eyes with and without PKP, respectively. Corneal transparency and vascularization, which were graded as 4+ before surgery, improved to a mean of 1.7 +/- 0.8 and 2.1 +/- 0.7 three months after surgery. Mean epithelial healing time was 8.8 +/- 4.1 [range 5 to 20] days. Longer healing occurred in 5 eyes due to small lenticules [n=2], exposure [n=2], and conjunctival encroachment [n=1]. Mean healing period for epithelial defects over PKP was 8.8 +/- 5.5 [range 4 to 14] days. Persistent epithelial defects occurred in 8 cases with cut lenticules [n=2], small-sized lenticules [n=2], and chronic exposure [n=4]. Lenticule-related complications were thick lenticules [n=4], conjunctival mantle encroachment [n=2], dislodging [n=4], progressive thinning [n=2], small size [n=3], and accidental trephination [n=2]. CLAU combined with AMT with or without PKP is effective in anatomical and visual rehabilitation of eyes with unilateral total LSCD. This procedure increases corneal transparency and decreases vascularization. The lenticules should be handled carefully in order to avoid most common lenticule-related complications