Ulus Travma Acil Cerrahi Derg. 2019; 25(2): 172-176 | DOI: 10.5505/tjtes.2017.18949

Penetrating keratoplasty in patients with traumatic corneal scarring

Dilay Özek, Özlem Evren Kemer, Mehmet Önen, Emine Esra Karaca
Department of Ophthalmology, Ankara Numune Training and Research Hospital, Ankara-Turkey

BACKGROUND: To evaluate the results of penetrating keratoplasty (PK) due to trauma-related corneal scarring.
METHODS: We evaluated 24 eyes of 24 patients who underwent PK due to trauma-related scarring of the cornea between May 2010 and June 2016. The postoperative visual acuity, graft transparency, and complications were evaluated.
RESULTS: The patients were divided into two groups. In group 1, 14 eyes of patients with traumatic corneal scars and retinal detachment underwent PK, pars plana vitrectomy, and intravitreal silicone administration with the help of temporary keratoprosthesis. Group I included five females and nine males with an average age of 39.15±13.32 (min 8–max 73) years. An intraocular foreign body was removed from five of the eyes. The mean visual acuity was 3.01±0.013 (3.10–1.00) logMAR after the surgery, 1.36±0.23 (3.10–0.80) at the postoperative first month, and 1.18±0.03 (3.10–0.70) at the end of the first year after the removal of keratoplasty sutures. During the follow-up of patients, two eyes (14.2%) lost light sensation, eight eyes (57.1%) developed postoperative glaucoma, nine eyes (64.2%) had graft rejection, and one patient (7.1%) developed keratitis. In one eye (7.1%), the cornea was scraped using ethylenediaminetetraacetic acid due to silicone-related band keratopathy. In group 2, ten eyes with trauma-related corneal scars underwent PK. This group included two females and eight males with an average age of 29.23±12.03 (11–63) years. The mean visual acuity was 2.98±0.68 (3.10–1.00) logMAR before the surgery, 0.58±0.22 (1.80–0.30) at the postoperative first month, and 0.50±0.17 (1.80–0.10) at the end of the first year. One eye (10%) with iridodialysis developed glaucoma. Rejection was not seen in any of the patients. A statistically significant difference was observed in both groups with regard to visual acuity before operation, at 1 and 12 months after operation, and at 12 months for graft transparency rates (p=0.015, p=0.021, p=0.001, respectively).
CONCLUSION: In cases of eye injuries due to trauma, the eyes subjected to combined vitrectomy and PK had poor visual prognosis and high graft rejection rate compared to those subjected to PK as the only treatment.

Keywords: Penetrating keratoplasty, temporary keratoprosthesis; traumatic corneal scar.

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Travmatik korneal skarlý hastalarda penetran keratoplasti

Dilay Özek, Özlem Evren Kemer, Mehmet Önen, Emine Esra Karaca
Ankara Numune Eðitim ve Araþtýrma Hastanesi, Göz Kliniði, Ankara

AMAÇ: Travma iliþkili korneal perforasyon skarý nedeniyle penetran keratoplasti (PK) uygulamalarýnýn sonuçlarýný deðerlendirmek.
GEREÇ VE YÖNTEM: Çalýþmamýza Mayýs 2010–Haziran 2016 tarihleri arasýnda travmatik korneal skar nedeniyle penetran keratoplasti uyguladýðýmýz 24 hastanýn 24 gözü alýndý. Ameliyat sonrasý hastalar görme keskinliði, greft saydamlýðý ve komplikasyonlar açýsýndan deðerlendirildi. Hastalar iki gruba ayrýldý. Grup 1’de travma ile iliþkili retina dekolmaný ve korneal perforasyon skarý olan 14 göz mevcut olup, bu hastalara PK, pars plana vitrektomi (PPV) ve intravitreal silikon verilmesi geçici keratoprotez (TKP) eþliðinde uygulandý. Grup 2’de 10 gözde sadece travma iliþkili korneal perforasyon skarý olup PK uygulandý.
BULGULAR: Grup 1’deki hastalarýn beþi kadýn, dokuzu erkek olup yaþ ortalamalarý 39.15±13.32 (8–73) yýldý. Beþ gözden intraoküler yabancý cisim çýkarýldý. Ortalama görme keskinliði LogMAR’a göre ameliyat öncesi 3.01±0.013 (3.10–1.00) iken ameliyat sonrasý birinci ayda 1.36±0.23 (3.10–0.80), keratoplasti sütürlerinin alýndýðý birinci yýlýn sonunda 1.18±0.03 (3.10–0.70) idi. Ameliyat sonrasý iki gözde (%14.2) ýþýk hissi kaybý geliþti ve evisserasyon yapýldý. Sekiz gözde (%57.1) týbbi tedavi ile kontrol altýna alýnabilen glokom, dokuz gözde (%64.2) greft rejeksiyonu, bir gözde (%7.1) keratit sonrasý lökom, bir gözde (%7.1) silikona baðlý bant keratopati geliþti. Bant keratopati geliþen gözde EDTA ile kazýma yapýldý. Grup 2’deki hastalarýn ikisi kadýn, sekizi erkek olup yaþ ortalamalarý 29.23±12.03 (11–63) yýldý. Ortalama görme keskinliði LogMAR’a göre ameliyat öncesi 2.98±0.68 (3.10–1.00) iken PK sonrasý birinci ayda 0.58±0.22 (1.80–0.30) ve keratoplasti sütürlerinin alýndýðý birinci yýlýn sonunda 0.50±0.17 (1.80–0.10) idi. Ýridodiyalizi olan bir gözde (%10) týbbi tedavi ile kontrol altýna alýnabilen glokom geliþti. Hiçbir hastada korneal rejeksiyon görülmedi. Her iki grup arasýnda PK sonrasý birinci ay ve 12. ay sonunda görme keskinlikleri ve greft saydamlýðý açýsýndan sýrasýyla fark istatistiksel olarak anlamlýydý (p=0.015, p=0.021, p=0.001).
TARTIÞMA: Göz travmalarýnda, ön ve arka segmenti ilgilendiren ve retina cerrahisi ile birlikte PK yapýlan gözlerde sadece ön segmenti ilgilendiren ve PK yapýlan gözlere göre görme prognozu ve greft saydamlýk oranlarý düþüktür.

Anahtar Kelimeler: Geçici keratoprotez, korneal skar; penetran keratoplasti.

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