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   Table of Contents      
ORIGINAL ARTICLE
Year : 1990  |  Volume : 38  |  Issue : 4  |  Page : 156-158

Healing of a graft in vascularized and non-vascularized corneal lesions


Department of Opthalmology, Medical College, Rohtak 124 001, India

Correspondence Address:
Nirupama Bhargava
Department of Ophthalmology University College of Medical Sciences, Delhi
India
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Source of Support: None, Conflict of Interest: None


PMID: 2086463

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  Abstract 

The healing of graft and visual results were compared in 21 vascularized and 29 non-vascularized corneal lesion. The healing and visual results were better in those cornea which were non-vascularized.


How to cite this article:
Bhargava N. Healing of a graft in vascularized and non-vascularized corneal lesions. Indian J Ophthalmol 1990;38:156-8

How to cite this URL:
Bhargava N. Healing of a graft in vascularized and non-vascularized corneal lesions. Indian J Ophthalmol [serial online] 1990 [cited 2019 Oct 16];38:156-8. Available from: http://www.ijo.in/text.asp?1990/38/4/156/25512



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  Introduction Top


The cornea is an avascular structure. The loss of avas­cularitr leads to loss of transparency and reduction in vision [1]. The status of vascularity of the cornea needs special attention while considering the healing of the graft after keratoplasty. Due to avascularity healing oc­curs slowly and over a prolonged period. Avascularity is an important factor in the acceptance of the graft. The loss of avascularity leads to change in the immune status of the host bed and possible rejection of the graft. Abidin [2]sub stated that avascular opacities surrounded by a zone of clear cornea were the most favourable for cor­neal grafting. Bavishi and Pate [3] reported that the failure rate was higher when opacities were associated with vascularization. However, Sayegh et al [4] reported that 55.7% of cases of corneal opacities associated with The vascularity of the cornea is considered to be one of the important risk factors for graft rejection after keratoplasty. The present study was undertaken to in­vestigate the healing process of corneal grafts in vas­cularized and non-vascularized corneal lesions.


  Materials and methods Top


The study was conducted on fifty cases of various corneal afflictions undergoing keratoplasty in the Department of Ophthalmology at Dr. S.N. Medical Col­lege and Hospital Jodhpur. The age and sex distribution of cases is given in [Table - 1]. The diagnosis wise distribution of patients is given in [Table - 2].

On the basis of vascularity of the cornea the patients were divided into two groups: the patients with vas­cularized corneal lesions and patients with non-vas­cularized corneal lesions. The vascularity in the cornea can be superficial, interstitial or deep. For the purpose of the present study the vascularity was graded on a three point scale (0-2).

0 - No vascularization

1 - Peripheral vascularization in two

or more quadrants.

2 - Corneal vessels located

within the optical zone.

The post operative results in the two groups were com­

pared with respect to :­

(i) Post operative acuity of vision.

(ii) Transparency of the graft.

(iii) Vascularity, and

(iv) Graft rejection.


  Observation and results Top


In all, 21 cases showed vascularization clinically and histopathologically. Out of these II cases were of Grade and 10 were of Grade II vascularization respectively. The incidence of clear and transparent graft was more in non-vascularized lesions. Amongst the cases of vas­cularized lesions the cases with Grade I vascularization had more clear and transparent grafts. The post opera­tive vascularization was more in previously vascularized lesions [Table - 3].

The preoperative visual status of the patients and the results after operation in the two groups are presented in [Figure - 4] and [Figure - 5]. The visual results after keratopiasty are better in non-vascularized lesions. The pre-opera­tive visual status in the vascularized lesions ranged from light perception to 6/60 with median being 0.015 and post-operatively it ranged from light perception to 6/36 with median being 0.045. In all, 10 cases showed vision better than before post-operatively and in 4 cases the vision worsened, while 4 cases had same post-opera­tively. In non-vascularized lesions the preoperative visual status ranged from light perception to 6/18 with median being 0.01 whereas post-operatively these resulted from light perception to 6/9 with median being 0.045. In all, 23 cases showed visual results better than before and in 3 cases the vision worsened and in 3 it remained the same[Table - 4].


  Discussion Top


It is advocated that the avascular opacities are better suited for graft healing and a clear corneal rim surround­ing the graft affects the healing process favourably. It is to test this that the present study was planned. The results show that healing with greater transparency of the graft was in avascular lesions. The results are in conformity with previous studies. [2],[3]

Vascularization of the graft occurs from the limbal ves­sels and is related to the distance of the graft from the limbus and concentration of toxins liberated by tissue injury. A pre-existing vascularization in the corneal rim may affect the healing due to extension of preformed vessels. Vascularization of the cornea may result in alteration of the immune status. Aurora [5] postulates that vascularization may increase the rejection rates.

When the results were compared in relation to the severity of vascularization, there were very little differen­ces. The visual results on the whole were better in non vascularized lesions.

Peritomy and subconjunctival injections of hydrocor­tisone are reported to prevent to some extent the post­operative vascularization in previously vascularized lesions, but non-vascular opacities are better suited for corneal grafting.

 
  References Top

1.
Madan Mohan, Vaid J and Angra SK (1981): Pathogenesis and control of corneal neovascularization. Indian J. Ophthal. 29, 393.  Back to cited text no. 1
    
2.
Abedin GF (1950): Corneal leucomata and their suitability for keratoplasty, Bull, Ophthalmic Soc. Egypt, 41, 81.  Back to cited text no. 2
    
3.
Bavishi, AK and Patel CK (1971): Report of 240 cases of Keratoplasty. Indian J. Ophthal. 27, IV, 123.  Back to cited text no. 3
    
4.
Sayegh, F, Ehlers N and Farah J (1988) : Evaluation of keratoplasty in cases of post-inflammatory corneal opacities with vascularization of viral or bacterial etiology. Acta, Ophth. 66, 404.  Back to cited text no. 4
    
5.
Aurora AL (1979). Corneal blindness, A Review. Indian J. Ophthal. 27 1, 1.  Back to cited text no. 5
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]
 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4]



 

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  In this article
Abstract
Introduction
Materials and me...
Observation and ...
Discussion
References
Article Figures
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