Monitoring the appositions of posterior graft–host junctions with anterior segment optical coherence tomogram after penetrating keratoplasty

Abstract

This study aimed to monitor the graft-host junction's (GHJ's) apposition with anterior segment optical coherence tomogram after penetrating keratoplasty (PK) and correlate the analysis with the preoperative diagnosis. Fifty-one eyes of 50 patients with various preoperative diagnosis of adherent leucoma, pseudophakic bullous keratopathy, corneal opacity or scarring, graft failure, corneal dystrophy and anterior staphyloma, who underwent PK for optical purposes were reviewed retrospectively. Based on the age, the patients were divided into groups 1 and II: those aged ≤40 and >40 years, respectively. Anterior segment optical coherence tomography was done for all these eyes to evaluate the posterior graft-host junction. All graft-host junction patterns were classified as well apposed, and malapposed with various components like hill, gap, step and tag. The comparisons of various clinical parameters were done for the various malapposed junction groups (hill, gap, step and tag). A total of 408 graft-host junction cross sections of 51 eyes were analysed. Amongst them 70 (17.15 %) sections were well apposed, and 338 (82.84 %) were malapposed. Most frequent type of malapposition was hill: 164 sections (40.19 %) followed by step: 139 sections (34.06 %). The distribution of graft-host junction alignment patterns varied amongst all the indications. Patients with preoperative diagnosis of adherent leucoma and corneal dystrophy had predominantly steps pattern in 65 (40.62 %) and 12 (75 %) sections, respectively. Hill pattern was seen predominantly in PBK, corneal opacity, graft failure and anterior staphyloma in 55 (42.96 %), 16 (40 %), 22 (45.83 %) and 8 (50 %) sections, respectively. Comparisons of various clinical characteristics like intraocular pressure, central corneal thickness, best-corrected visual acuity, astigmatism and size of graft with the various malapposed patterns showed significant differences in best-corrected visual acuity and keratometric astigmatism in the hill pattern of malapposition group with p values of .004 and .053, respectively, using independent T test. Posterior graft-host junction analysis with anterior segment optical coherence tomography is very important for post penetrating keratoplasty management. The posterior wound profile differed according to the indications of penetrating keratoplasty. Best-corrected visual acuity and keratometric astigmatism showed significant difference with the malapposition hill (pattern).

Malapposition of graft-host interface after penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK): an optical coherence tomography study

“…Therefore, AS-OCT has been used to observe alignment patterns of the posterior graft-host junctions after PK. However, similar observations after DALK have rarely been reported [10,11].…”

Malapposition of Graft-host Interface after Penetrating Keratoplasty (PK) and Deep Anterior lamellar Keratoplasty (DALK): an optical coherence tomography study

“…20 Until now, there have been conflicting opinions about the causes of postoperative astigmatism; these include small intraoperative trephinations, uneven suture tension and graft-recipient misalignments. 8,11 Limberg et al 15 proposed that imprecise graft-host matching might result in astigmatism of about 4 to 6 diopters. 1 Kaiserman et al 11 reported slight misalignment-associated astigmatism after PK.…”

“…8,11 Limberg et al 15 proposed that imprecise graft-host matching might result in astigmatism of about 4 to 6 diopters. 1 Kaiserman et al 11 reported slight misalignment-associated astigmatism after PK. Jhanji et al 17 categorized the alignment patterns as step and ledge, but failed to describe the relevance of malappositions to postoperative visual outcomes.…”

“…However, similar observations after DALK have rarely been reported. 10,11 To-date, knowledge of the factors influencing postsurgical refractive errors has remained inconclusive because of insufficient relevant reports. Kaiserman and Bahar 12 reported that internal graft-host malappositions were associated with increased postoperative ametropia.…”

Malapposition of Graft-host Interface after Penetrating Keratoplasty (PK) and Deep Anterior lamellar Keratoplasty (DALK): an optical coherence tomography study

“…20 Until now, there have been conflicting opinions about the causes of postoperative astigmatism; these include small intraoperative trephinations, uneven suture tension and graft-recipient misalignments. 8,11 Limberg et al 15 proposed that imprecise graft-host matching might result in astigmatism of about 4 to 6 diopters. 1 Kaiserman et al 11 reported slight misalignment-associated astigmatism after PK.…”