Endothelial Graft Failure After Contralateral Autologous Corneal Transplantation

Abstract

Purpose To report on outcomes after contralateral autologous penetrating keratoplasty (APK). Methods Design Case series. Patient population 5 patients who received a contralateral APK and a simultaneous allogeneic PKP in the donor eye at the Bascom Palmer Eye Institute and the Miami Veterans Affairs Hospital. Results The median patient age at the time of surgery in our 5 patients was 67 years (range, 58–88 years); 4 patients were male and 1 female, 1 patient was white and 4 black. The surgery was uneventful in all cases and no operative or immediate post-operative complications occurred in either eye. Follow-up time ranged from 18–54 months (mean, 35 months; median, 34 months). During this time, 4 of the autologous grafts failed due to endothelial attenuation. Identified risk factors for failure in the autologous eyes included the presence of a glaucoma tube (5/5), previous graft failure (4/5) and anterior synechiae in (2/5). Conclusion This study is the first to describe graft failure due to slow endothelial attenuation after APK. This study underscores the importance of non-immunologic factors in endothelial cell loss after corneal transplant surgery and highlights the need for further research to understand and modulate endothelial loss.

Semi-Autologous Corneal Transplantation with Simultaneous Bilateral Surgery: A Case Report

“…Therefore, we decided to proceed with a contralateral autologous PK as tissue isogeneity would be associated with a lower the risk of rejection compared to an allograft [3]. Up to this date, 103 cases of contralateral APK have been reported in the literature with an overall success rate of 77.4% at a mean follow-up time of 54 months [3,4,[13][14][15]. The results of the APK case reports published in the last 10 years are summarized in Table 1.…”

“…Our patient met the criteria for contralateral APK by having an opacified cornea in their potentially seeing right eye and a clear cornea in their left eye, which had poor vision due to amblyopia. Therefore, we decided to proceed with a contralateral autologous PK as tissue isogeneity would be associated with a lower the risk of rejection compared to an allograft [3]. Up to this date, 103 cases of contralateral APK have been reported in the literature with an overall success rate of 77.4% at a mean follow-up time of 54 months [3,4,[13][14][15].…”

“…In contralateral APK, the opacified cornea of a potentially seeing eye is replaced by the clear cornea of the patient's contralateral eye, which has low or no vision, due to a non-corneal disease [4]. Although these criteria are not frequently met, contralateral APK has demonstrated positive results in several retrospective case series [3][4][5][6]. Other options in patients with multiple graft failures include a repeat PK with systemic immunosuppression using calcineurin inhibitors and antimetabolites [5], or the use of a keratoprosthesis, such as the Boston keratoprosthesis type 1 (Kpro) [6].…”

“…Autologous penetrating keratoplasty (APK) is a valuable procedure that minimizes the risk of allograft rejection and the need for postoperative steroids, due to tissue isogeneity [ 3 ]. This makes it a viable option for patients with multiple graft failures and/or suboptimal medication compliance.…”