ABSTRACT
Primary graft failure is a rare but major complication of penetrating keratoplasty. An apparent clustering of four cases during a 1-month period led to a review of all 778 keratoplasties performed by nine surgeons at Massachusetts Eye and Ear Infirmary from July 1, 1986 to June 30, 1988. The objectives of this study were (a) to investigate the possibility that cases of primary graft failure occurred in clusters within their physical environment of space, time, and personnel and (b) to determine the frequency of and evaluate possible risk factors for primary graft failure. Twenty-one cases of primary graft failure were found, resulting in an incidence rate of 2.7% during this period. A 13.3% incidence of primary graft failure was found in donor mates, suggesting improper tissue preparation. The charts and eye bank records of the 21 cases and 84 age-matched controls, randomly selected from the group of all keratoplasties, were reviewed for donor-, recipient-, surgeon-, and surgery-related characteristics. Improper tissue preparation was not associated with primary graft failure. An individual surgeon was the most significant risk factor [odds ratio = 6 (95% CI: 2.1-17.0)].
Subject(s)
Graft Rejection/epidemiology , Adult , Boston/epidemiology , Case-Control Studies , Cluster Analysis , Eye Banks/standards , Graft Rejection/etiology , Graft Survival , Humans , Incidence , Keratoplasty, Penetrating/adverse effects , Middle Aged , Risk Factors , Tissue Donors , Tissue and Organ Procurement/methodsSubject(s)
Anterior Chamber/injuries , Eye Injuries/complications , Hyphema/therapy , Humans , Hyphema/etiologySubject(s)
Anti-Bacterial Agents/therapeutic use , Cataract Extraction , Endophthalmitis/prevention & control , Premedication , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/economics , Conjunctiva , Humans , Injections , Postoperative Complications/prevention & controlABSTRACT
Frequently, patients with lens laceration or traumatic cataract coincident with corneal laceration, or both, must undergo two separate procedures-primary repair of the corneal laceration and secondary lens removal with or without intraocular lens implantation. We performed simultaneous corneal laceration repair, extracapsular cataract extraction, and posterior chamber lens implantation in seven patients with lacerating ocular injuries who met inclusion criteria for this procedure. With average follow-up of 10 1/2 months, all seven patients achieved visual acuity of 20/40 or better with spectacle correction. YAG posterior capsulotomy was the only additional procedure. One patient had macular pigmentation consistent with either traumatic or photic maculopathy. There were no other complications attributable to the surgical procedures. We believe that certain lacerating injuries of the anterior segment are particularly amenable to cataract extraction and lens implantation at the time of primary laceration repair. This approach obviates additional operative and anesthetic risks, while affording more timely visual rehabilitation.
Subject(s)
Cataract Extraction , Cornea/surgery , Corneal Injuries , Eye Injuries, Penetrating/surgery , Lenses, Intraocular , Adult , Anterior Chamber/surgery , Eye Foreign Bodies/surgery , Follow-Up Studies , Humans , Lens, Crystalline/injuries , Male , Middle Aged , Postoperative Complications , Treatment Outcome , Visual AcuityABSTRACT
Secondary tumors of the optic nerve are more common than primary optic nerve tumors. The involvement of the optic nerve may arise from direct invasion from intraocular malignancies, from hematopoietic malignancy, from meningeal carcinomatosis, or from distant primary tumors. Orbital tumors rarely invade the optic nerve, and brain tumors involve it only in their late stages.
