A Case of Necrotizing Keratoscleritis in Primary Sjogren's Syndrome

We report on a case of necrotizing keratoscleritis in primary Sjogren's syndrome. A 66-year-old female patient who was complaining of ocular pain, tearing and decreased vision in her right eye for the previous two days was admitted to our hospital. Visual acuity in the right eye was hand movement, and initial examination showed a 3.0 x 1.8 mm uveal mass bulging through a corneoscleral melting site in the nasal region of the right eye. Positive anti-nuclear antibody was identified at a titer of 1:320 with a speckled pattern, and both Sjogren's syndrome A and Sjogren's syndrome B antibody tests were positive, with titers >200 U/mL. A technetium 99m pertechnetate salivary scan revealed chronic sialoadenitis in the submandibular glands. We diagnosed the lesion as necrotizing keratoscleritis due to primary Sjogren's syndrome. A corneoscleral patch graft was performed, followed by immunosuppression including oral cyclosporin and topical prednisolone. During a follow-up period of 12 months, the corneoscleral graft was well maintained with no recurrence.

Surgical Results of Repeat Penetrating Keratoplasty and Risk Factors for Graft Failure

PURPOSE: To evaluate the primary indications, surgical outcomes, causes and risk factors for failure in patients with repeat corneal transplantation. METHODS: We retrospectively analyzed indications for the initial corneal graft, best corrected visual acuity, survival period, corneal clarity, cause and risk factor for failure in 42 patients (45 eyes) who underwent repeat penetrating keratoplasty with a minimum follow-up period of 6 months. RESULTS: The most common primary indications were herpes simplex keratitis (21.4%), followed by corneal scar (19.0%) and pseudophakic bullous keratopathy (9.0%). The average period of repeat corneal transplantation was 19.1 +/- 24.9 months. The most common cause of the failure of penetrating keratoplasty was allograft rejection(79.3%). The risk factors of graft failure were corneal neovascularization, chronic inflammation and the number of regrafts. CONCLUSION: The most common primary indication of repeat corneal transplantation was herpes simplex keratitis. The mean survival period was about 19 months. The factors that appeared to influence the survival period of repeat corneal transplantation were the corneal neovascularization, chronic inflammation and the number of regrafts.

Clinical Evaluation of the Graft Rejection after Penetrating Keratoplasty

In order to evaluate risk factors (sex, age, preoperative diagnoses, graft size, neovascularization of the recipient cornea, bilaterality, history of the previous graft failure, doner corneal preservation method, phakic status, glaucoma and enucleation time after death) influencing graft rejection, we reviewed 96 eyes underwent penetrating keratoplasty at the Chonnam University Hospital from May 1992 to December 1995, retrospectively. The rate of the graft rejection in penetrating keratoplasty was 34.3% (33 eyes). In detail, graft rejection occurred in 16 eyes(47%) among 34 vascularized corneas of recipient(R=18.0, P=0.000), 23 eyes(69.7%) among 33 vascularized orneas of donor side after operation (R=0.3, P=0.010), 5 eyes(35.7%) among 14 bilateral grafts, 4 eyes (57.1%) among 7 eyes having a history of graft failure, 6 eyes(40.0%) among 15 aphakic eyes(R=3.84, P=0.033), and 14 eyes among 32 eyes enucleated longer than 6 hours after death (R=10.1, P=0.002). In contrast, graft rejection occurred in 13 eyes (76.5%) among 17 postoperative glaucomatous eyes and in 20 eyes (25.3%) among 79 postoperative non-glaucomatous eyes, there was no statistically significant difference between two groups(P>0.05). These results suggest that neovascularzation of the either donor or recipient cornea, aphakic status of the recipient eyes, and enucleation time longer than 6 hours after death are high risk factors for graft rejection.