ABSTRACT
Introduction: Corneal disease ranks 5th among the causes ofblindness and it forms 7.1% of total blindness and is a seriouspublic health problem resulting in medical and economicburden to the nation. A study was carried out to evaluateregrafts with emphasis on factors which caused failure oforiginal graft and factors influencing graft success after repeatPK.Material and methods: The prospective study consisted ofcases of graft failure attending Eye Bank Clinic at CommandHospital, Kolkata, from Jan 2017 to Dec 2018. Intervalbetween primary graft and repeat PK was minimum of 06months. All the surgeries were performed by a single surgeon.Results: Out of 164 PK, 28 regraft (17.07%) were performed.The regrafting were carried out on cases of graft failure dueto endothelial failure (39.3%), allograft rejection (17.8%),recurrence of disease (14.2%), secondary glaucoma (10.7%),ocular surface disorder and dry eye (10.7%), Pseudomonasinfection (3.6%) and unknown (3.6%). In 13 cases simplerepeat keratoplasty and in rest 15 cases combined procedureswere done. 17 cases (60.7%) had clear regrafts and in 11cases the regraft became opaque during follow up period of06 months to 2 years (average 12.6 months). Pseudophakicbullous keratopathy had greater rate of clear regrafts (71.4%).09 out of 11 cases of failure had one of the preoperative factorslike raised IOP, anterior synechiae, corneal vascularizationand younger recipient age group. Vascularization of recipientbed was associated with greater rate of graft failure (60%).Conclusions: Better visual outcome and graft survival inregraft can be achieved by understanding the underlyingpathology and formulating a preoperative plan.
ABSTRACT
<p><b>OBJECTIVE</b>To compare the clinical effect between the lamina osteotomy and former vertebral plates regraft method and total laminectomy and interbody fusion method in treating single-segment lumbar degenerative disease.</p><p><b>METHODS</b>The clinical data of 167 patients with single-segment lumbar degenerative disease underwent surgical treatment from January 2010 to December 2014 were retrospectively analyzed. There were 92 males and 75 females, aged from 45 to 75 years old with an average of (59.6±12.4) years. The patients were divided into lamina osteotomy and former vertebral plates regraft group(82 cases) and total laminectomy and interbody fusion group(85 cases) according to the different surgical methods used. The general conditions and clinical effects were compared between two groups. General conditions included the operation time, intraoperative blood loss, postoperative drainage, hospitalization time and the clinical effects included the visual analogue scale (VAS), Japanese Orthopaedic Association(JOA), Oswestry Dability Index(ODI), MacNab results, epidural fibrosis (EF), the incidence of adjacent segment degeneration (ASD).</p><p><b>RESULTS</b>All the patients were followed for 18 to 36 months with an average of (24.8±5.7) months, furthermore, there was no significant difference in the follow-up time between two groups. There was no significant difference in general conditions such as operation time, intraoperative blood loss, postoperative drainage, or hospitalization time between two groups. At final follow-up, the VAS, ODI, JOA, of all patients were significantly improved (<0.05);and the three factors above in the lamina osteotomy and former vertebral plates regraft group respectively were(2.0±1.1) points, (24.0±1.8) %, (19.8±8.2) point, while the results of total laminectomy and interbody fusion group were(2.5±1.6) points, (23.3±2.0)%, and(22.5±8.5) point;there was statistical difference between two groups(<0.05). According to the standard of MacNab, 59 cases obtained excellent results, 20 good, 3 fair results in the lamina osteotomy and former vertebral plates regraft group;while 47 cases got excellent results, 26 good, and 12 fair results in the total laminectomy and interbody fusion group;there was significant difference between two groups(<0.05). Sixteen patients(19.51%) with EF and 20 patients(24.39%) with ASD were found in lamina osteotomy and former vertebral plates regraft group;and 30 patients(35.29%) with EF and 37 patients(43.53%) with ASD were found in total laminectomy and interbody fusion group; there was significant difference between two groups(<0.05).</p><p><b>CONCLUSIONS</b>Both two methods can achieve the ideal effects for the treatment of single-segment lumbar degenerative disease, but the lamina osteotomy and former vertebral plates regraft method can reserve the integrity of posterior ligamentous complex, reducing the incidence of EF and ASD, and is a better surgical method.</p>