Emergency corneal grafting in the UK: a 6-year analysis of the UK Transplant Registry

Abstract

BackgroundCorneal graft (CG) surgery is the most common and successful tissue transplant worldwide. A small and important group of patients are operated in emergency situations, typically to save a perforated eye. Our knowledge of the indications and outcomes of emergency corneal graft (eCG) is limited.MethodsRetrospective, multifactorial analysis of all CGs registered by the UK Transplant Service from April 1999 to March 2005.ResultsA total of 12 976 CGs were performed. 1330 (11.4%) were eCGs including 433 regrafts. Actual perforation occurred in 876 (65.9%) patients. 420 (31.5%) grafts were for tectonic purposes alone and 217 (16.3%) were also grafted for visual rehabilitation. The main diagnostic categories were infection (39.4%), non-infectious ulcerative keratitis (32.2%) and other causes (ectasias, previous ocular surgery, injury, dystrophies and opacification). Graft survival of first eCG at 1, 2 and 5 years was 78%, 66% and 47%, respectively. Best-corrected visual acuity of surviving grafts at 1 year was: 6/12 or better in 29.9%, 6/18 to 6/60 in 38.4%, counting finger to LP in 30.6% and NPL in 1%, with worsening of vision in only 8.7% of the patients.ConclusionThis study which is the largest of its kind shows that despite the seriousness of the critical corneal pathology and the surgical challenges that it poses, the outcomes of eCG are favourable with most patients keeping their eyesight and avoiding immediate rejection. These clinical outcomes show the value of eye banking facilities that are developed to support corneal tissue supply for eCG.

Total Penetrating Keratoplasty: Indications, Therapeutic Approach, and Long-Term Follow-Up

“…In the current study, despite the uncertain and frequently inauspicious preliminary prognosis, repeated tectonic surgery and multidrug immunosuppression, overall graft survival, and final globe restoration were achieved in more than half of the eyes treated. This result is comparable with other studies [ 4 , 18 ]. Groups of patients with extremely large corneoscleral grafts are usually small may be dependent on geographical and ethnic conditions (variability), and statistics may not be representative, which is also emphasized by other authors [ 2 , 4 , 15 , 19 , 20 ].…”

“…Delayed epithelialisation or persistent epithelial defect determined a significant graft failure rate and contributed to the higher rate of ocular surface complications [ 3 ]. The final result of this complication often leads to repeated tectonic and reconstructive surgery [ 4 , 9 , 20 ].…”

“…Urgent reconstructive surgical interventions may be necessary to avoid consecutive endophthalmitis and the formation of the anterior and posterior synechiae and secondary glaucoma and to prevent the spread of pathogens toward the posterior pole of the eye globe or to avoid other severe complications [ 1 – 4 ]. The optical result of urgent surgical treatment is less important; if possible, visual restoration or rehabilitation may be accomplished in the future.…”

“…Initial difficult and complicated medical status, despite a wide spectrum of pharmacological and surgical treatments, may result in fatal treatment failure with loss of the eye. The poor visual outcome of rapid corneal surgery may require further surgery [ 1 , 4 – 6 ].…”

Long-term outcomes of riboflavin photodynamic antimicrobial therapy as a treatment for infectious keratitis

“…However, performing a corneal transplant on an infected and inflamed ocular surface increases the risk of graft failure or graft rejection. 1 …”