Prevention of Keratograft Decompensation after Penetrating Keratoplasty in Combined Optical-reconstructive Surgery for Combat Eye Trauma

Abstract

Purpose: to evaluate the long-term results of penetrating keratoplasty (PK) as an element of optical reconstructive surgery (ORS) in combat eye injury (CEI), to identify risk factors for transplant decompensation and their prevention.
Patients and Methods. The study included 39 patients (22–59 years old) divided into two groups: Group I — open globe injuries (OGI) with anterior and posterior segment structures failures (37 eyes) and Group II — anterior segment inflammation, complicating CEI with an intact posterior segment (6 eyes). All patients underwent PK, and in Group I ORS were performed also. Outcome measures included visual acuity, graft epithelialization rate, and graft transparency.
Results. Postoperative visual acuity was significantly higher in group II — 0.23 ± 0.12 (from 0.05 to 0.3) versus 0.05 ± 0.08 (from 0 to 0.4) in group I. The epithelialization time in group I was significantly shorter than in group II — 8.05 ± 3.86 versus 25.24 ± 11.87 days. In group I, transparent engraftment was observed in 62.16 % of cases, semitransparent — in 35.14 % of cases, and cloudy — in 2.70 % of cases. In group II, transparent engraftment was observed in 83.33 % of cases, cloudy — in 16.67 % of cases, which was significantly higher. Keratograft contact prevention with the vitreous cavity contents in Group I reduced the rate of opaque graft engraftment from 61.5 % to 16.7 %. Correlations affecting the functional outcome after surgery were identified.
Conclusions. Posterior segment surgery after PK decreases survival of corneal transplant due to endothelium contact with vitreous cavity contents. Therefore, the primary goal of multi-stage ORS is to distinguish anterior and posterior eye segments.