|Year : 1979 | Volume
| Issue : 4 | Page : 123-125
Report of 240 cases of keratoplasty
Anil K Bavisi, Chhotubhai K Patel
Above Imperial Hotel, Near Cinema, Relief Road, Ahmedabad, India
Anil K Bavisi
Above Imperial Hotel, Near Cinema, Relief Road, Ahmedabad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bavisi AK, Patel CK. Report of 240 cases of keratoplasty. Indian J Ophthalmol 1979;27:123-5
Keratoplasty is no longer a surgical tour de force but is a procedure present in the armamentarium of ophthalmic surgeons. Corneal pathology is one of the leading causes of blindness in India. Fortunately however, rnajor portion of this blindness is either preventable or can be improved with keratoplasty.
The aim of the present study is to report our experience on a series of 240 keratoplasty cases carried out between June 1973 and June 1976, which have been followed up for a period varying from 3 months to 3 years.
| Methods and material|| |
240 keratoplasties were performed in 240 cases selected from the corneal clinic at Nagari eye hospital. Out of these 58 had lamellar (Group I) and 182 had full thickness (Group 11) corneal grafts. The age of the patients undergoing keratoplasty has been summarised in the [Table - 1]
Out of the 240 patients, 158 were males and 82 were females; roughly a ratio of 2:1.
Possible causes of corneal opacification in these cases are summarised in [Table - 2]
Eyes were removed in 95% cases within 4 to 8 hours after death, while in the remaining cases they were removed after 12 hours of death. The eye-balls were preserved and used in the standard manner. The bulk of the material were from voluntary donors.
| Observations and comments|| |
Group I: Lamellar keratoplasty (58 cases): Lamellar keratoplasty was performed in 58 cases which included 48 optical, 8 therapeutic, and 2 preparatory grafts. Therapeutic grafting was performed on 8 cases. Two were bacterial corneal ulcer and 6 recurrent dendritic ulcer. Healing in these cases was good but improvement in vision was recorded only in 4 cases upto 2/60.
The grafted cornea remained completely transparent in 28 cases, 16 cases showed one or two punctate opacities, while in the remaining 14 cases the graft became completely opaque. In 14 cases lamellar keratoplasty was performed even though the opacity in the recipient cornea was deep. The subsequent follow up of the cases showed that there was a gradual thinning of the opacity which was left behind in the host bed. It was observed that failure rate was high in the cases where corneal opacity was associated with vascularisation, herpes simplex and corneal ulcers with bacterial infection.
(i) Visual improvement
70% of cases of lamellar keratoplasty showed significant visual improvement which ranged from 1/60 to 6/12. In five cases though the graft remained completely, transparent improvement in vision was poor due to amblyopia, high myopia and lenticular opacity.
(ii) Complications in lamellar keratoplasty
The commonest complication encountered was vascularisation [Table - 3]. The 4 instances of post-operative necrosis were seen among the therapeutic group.
Group II: Penetrating keratoplasty
(A) Types of penetrating keratoplasty:
Out of 182 cases, 130 were partial penetrating, 46 total penetrating and in 6 cases keratoplastics were with scleral ring.
(B) Sizes of grafts used have been shown in [Table - 4].
(C) Transparency of penetrating graft.
Out of 182 cases, the grafts remained transparent in 86 cases (47%), partially transparent in 36 cases (20%) and became opaque in remaining 60 cases - (33%). The failures were mainly in cases where graft size was 10mm or more or when total keratoplasty was performed in anterior staphyloma or adherent leucomes. (D) Visual results in penetrating keratoplasty (done for optical purposes).
Visual improvement was observed in 67% of cases which ranged between 1/60 to 6/12. In 32 cases visual improvement was not good inspite of the transparent graft. This was due to either amblyopia with or without squint or lenticular opacities, high myopia, optic atrophy (one case). The main operative complications in these series were lens extrusion and vitreous loss in 40 cases. This, we feel, due to of over enthusiasm to do a kcratoplasty in wrongly selected cases or mercy keratoplasty done in cases of anterior staphylomas.
In 6 cases keratoplasty was done with scleral rim, larger ones being 18 mm., 15 mm. and 14 mm respectively. One case was that of injury to a butcher by a bone while cutting meat. On the 3rd day of admission the whole cornea came out with pad. We tried in this case some 18 mm diameter graft. It remained transparent for about 3 months but ultimately it turned opaque. However, the cosmetic result was good.
Ectasia of the graft and glaucoma were two significant post-operative complications found in our series. They were associated with adherent leucoma and anterior staphyloma and frequently follow total keratoplasty.
Our results were poor in children below 5 years. Only in one case graft has remained transparent so far with 3/60 vision.
It was our experience that when eyes were utilised within 24 hours, results were much better than when utilised after 2 to 3 days. The age of the donor varied from 6 months to 72 years. Incidently in a case where we used donor cornea of 6 months old patient, graft remained transparent.
[Table - 1], [Table - 2], [Table - 3], [Table - 4]