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   Table of Contents      
ARTICLE
Year : 1983  |  Volume : 31  |  Issue : 5  |  Page : 674-679

Factors affecting transparency of graft in keratoplasty


Deptt. of Ophthalmology, Medical College, Indore, India

Correspondence Address:
P C Mittal
Deptt. of Ophthalmology, Medical College, Indore
India
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Source of Support: None, Conflict of Interest: None


PMID: 6200437

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How to cite this article:
Mittal P C, Nahata M C, Moghe R. Factors affecting transparency of graft in keratoplasty. Indian J Ophthalmol 1983;31:674-9

How to cite this URL:
Mittal P C, Nahata M C, Moghe R. Factors affecting transparency of graft in keratoplasty. Indian J Ophthalmol [serial online] 1983 [cited 2019 Aug 20];31:674-9. Available from: http://www.ijo.in/text.asp?1983/31/5/674/36630

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Graft transparency is of paramount importance for successful keratoplasty. Trans­parency is affected by many factors. These factors are related not only to the type of donor material but also to condition of the recipient eye besides the operative procedures and post-operative treatment.

The quality of donor material depends upon the age of donor, cause of death, interval between time of death and time of enucleation, the duration for which the donor eye was preserved, clinical condition of the donor eye, its bacteriological and method of preservation.

The factors which are related to the recipient eye, are the cause and extent of corneal pathology, corneal vascularisation and other associated ocular pathology.

The operative factors which can affect the transparency, are the size of graft, the suture material used, operative technique and the complications. Post-operative complications and post operative treatment are important factors which governs the tranparency of graft. Looking to the high incidence of corneal blindness is of vital importance, this study was taken-up with a view not only to study the donor material but also the recipient eye besides the operation procedures and complications.


  Material and Methods Top


The present study 40 cases of penetrating keratoy plasty done under following headings.

(i) Donor material, (ii) Detail clinical examination of donor eye, (iii) Investigations of the recipient, (iv) Pre-operative preparation, (v) Operative technique, (vi)

Post-operative treatment, (vii) Follow-up.

During dressing following points noted down:

(i) Clarity, of graft, (ii) Position of graft, (iii) Any graft reaction, (iv) Position and tightness of suture, (v) Graft edges, (vi) Neovascularization, (vii) Any evidence

of epithelial ulcer, (viii) State of anterior chamber, (ix) Any evidence of synaechia formation, (x) State of pupil, (xi) Relief of symptoms, (xii) Visual improvement.

Follow-up

Regular follow-up every 4 weeks was done, while the patient were maintained on topical steroids drops 4 times a day.

Following points were noted on the follow-up.

i) Clearity of graft

ii) Intraocular pressure

iii) Corneal sensations

iv) Neovascularisation

v) Visual acuity.


  Discussion Top


Factors Pertaining to the Donor Material:

In the present study it is observed that the age of the don or is not a important factor. Similar views are expressed by Dhanda and Kelever [1] , Casey [2] and Maumenee [3] . Eyes of young children below 5 years of age are definitely unsuitable. The donor corneas were not taken from the patients who died of malignancy, burns, drowning, poisonic and snake bites. Casey [2] and Dhanda & Keleveri were also of the same view.

In this series 24 donor corneas were used, which were enucleated within 4-6 hours after death. Out of these 24 grafts, 20 (83.3%) grafts remained transparent while two (8.3%) became cloudy and two (8.3%) became opaque. In 6 cases death enucleation interval was more than 10 hours where only two (33.3%) remained transparent. No doubt climatic condition are also important. Those two cases which were transparent, were done during winter season. Therefore it is observed that where death enucleation interval is short the percentage of ultimate transparency of graft is more.

The best results were obtained in those cases where deaft-surgery interval was less than 10-12 hours.

In the present study 65% of eyes were sterile and 35 eyes showed the growth of pathological organism. But only 4 cases (10%) developed infection, and two out of these 4 cases were controlled by medical line of treatment. One case which developed infection was of perforated corneal ulcer.

Factor Pertaining to recipient Cornea

In cases of corneal opacity all the cases were having, clear and healthy zone of cornea around the corneal opacity. Surprisingly the success rate was 50% in these cases which is a lower rate as compared to success rate described by Arruga [4] - 80%, and Paton [5] - 70%. The low percentage of success in our series can be described on long standing corneal pathology of recipient eyes. In adherent leukoma cases the success rate was 60%., While Arruga [4] , Paton [5] described poor results in adherent leukoma. In present series two cases of per­forated corneal ulcer and two cases of conical cornea were subjected to transplantation. In all these four cases the results were poor. In perforated corneal ulcer the results were des­cribed poor by Arruga[4] and Paton[5] . But in conical cornea most of the workers have reported excellent results.

In our series of two cases of keratoconus one developed secondary glaucoma and in other persistant shallow anterior chamber was noticed.

In present study 16 cases were having no vascularisation, 14 (87.7%) cases remained transparent. 10 cases were having mild vas­cularisation, where success rate was 80%. In cases where vascularisation was severe the ultimate results were very poor. These has been reported by more or less all the previous workers. It is confirmed that smaller the size of graft better the result as also shown by other workers.

Operative complications and Transperancy of graft

Operative complications have got a major role in ultimate transparency of graft. Slightest damage to the donor endothelium can causes poor results as shown in our series. In 4 cases damage to donor endothelium occurred during the handling of the graft at the time of its preparation and all 4 cases turned opaque. In 4 cases irregularity in trephining recipient cornea occured and in these cases periphereral ant. synechia developed beause of shallow anterior chamber and the overall results were poor.

Post operative complication and other relation to graft clarity

Peripheral anterior synechias were responsi­ble for the development of secondary glaucoma in our series which was 15% while in series of Athot (1979) it was 13%. According to Moore and Aroson [6] secondary glaucoma was res­ponsible for the 7% of graft failure while ultimate graft failure was 10% in our cases which developed secondary glaucoma.

Vascularisation of graft was observed in 16 cases (40%) out of which 8 cases (50%) remained transparent while 4 cases (25%) became cloudy and 4 cases (25%) opaque. The cases which turned opaque and cloudy were having other post operative complications also. In our series 10% of cases developed epithelial ulcerations, and iridocyclitis. The cases of iridocyclitis were controlled but the cases of epithelial ulceration turned opaque. Thus it is observed that iridocyetitis is not responsible for graft failure. Stitch infection seen in 4 cases (10%) which disappeared after removal of stitches. 4 cases developed infection. In these two cases donor cornea showed contamination. (One case the donor material was obtained from the patient died of faecal fistula) Khodadaust [7] reported infection in those cases where donor material was obtained from the patient died of septicimia. In our series 4 (10%) cases showed graft rejection along with other complications,


  Summary Top


40 cases of corneal transplantation were studied to find out the factors affecting the transparency of graft. The commonest lesion for which corneal transplantation was done was corneal opacity 40%, adherent leukomas 25%, non healing corneal ulcer, 15%, regraft­ing 15% and conical cornea with corneal opacity in 5% of cases.

The graft size used was ranging 7th to 8 mm. common operative complications were difficulty in air injection 20%, damage to donor endothelium 10%, irregularity in trephining the recipient cornea and iris prolapse 5%. Commonst post operative complications were graft vascularisation 40%, peripheral anterior synechia 20%; secondary glaucoma 15%, graft injection 10%, stitch infection 10%, graft rejection 10% and graft ulceration 5%. The overall results were 65% transparent grafts, 20% cloudy grafts and 15% opaque grafts.

The factors affecting the ultimate transpar­ency of graft depends on correct choice of donor cornea, condition of recipient cornea, operative procedures and post operative complications and their management.

 
  References Top

1.
Dhanda, R.P., Kelever, V., Corneal surgery little. Brown and Co. Boston, U.S.A., 1972.  Back to cited text no. 1
    
2.
Casey, T.A., Corneal grafting, Butter Worth, & Co. London_, 1972.  Back to cited text no. 2
    
3.
Mauminee, A.E., Cited in graft failure of symposium of Ciba foundation, 1973.  Back to cited text no. 3
    
4.
Arruga, H., Ocular Surgery, Me Graw London, pp. 399, 1952.  Back to cited text no. 4
    
5.
Paton, R.T., Arch. of Ophthal., 48, 344, 1952.  Back to cited text no. 5
    
6.
Moore. T.E., & Aronson, S.B., Graft failure, Ciba foundation, 1972.  Back to cited text no. 6
    
7.
Khodadaust, Cited in Graft failure, Symposium Ciba foundation, 1972.  Back to cited text no. 7
    



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7], [Table - 8], [Table - 9], [Table - 10], [Table - 11]



 

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