|Year : 1990 | Volume
| 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
Department of Ophthalmology University College of Medical Sciences, Delhi
Source of Support: None, Conflict of Interest: None
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
| Introduction|| |
The cornea is an avascular structure. The loss of avascularitr leads to loss of transparency and reduction in vision . 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 sub stated that avascular opacities surrounded by a zone of clear cornea were the most favourable for corneal grafting. Bavishi and Pate  reported that the failure rate was higher when opacities were associated with vascularization. However, Sayegh et al  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|| |
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|| |
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|| |
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. ,
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  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|| |
Madan Mohan, Vaid J and Angra SK (1981): Pathogenesis and control of corneal neovascularization. Indian J. Ophthal. 29, 393.
Abedin GF (1950): Corneal leucomata and their suitability for keratoplasty, Bull, Ophthalmic Soc. Egypt, 41, 81.
Bavishi, AK and Patel CK (1971): Report of 240 cases of Keratoplasty. Indian J. Ophthal. 27, IV, 123.
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.
Aurora AL (1979). Corneal blindness, A Review. Indian J. Ophthal. 27 1, 1.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]
[Table - 1], [Table - 2], [Table - 3], [Table - 4]