Price graft-over-host technique to manage positive pressure during penetrating keratoplasty

Abstract

Intraoperative positive pressure with resulting iris and lens prolapse can pose a difficult scenario during penetrating keratoplasty. In the Price graft-over-host technique, the graft is sutured across the trephinated host cornea, which maintains a formed anterior chamber and thus avoids intraoperative complications. The technique was used in 33 eyes, and no primary or secondary graft failures occurred. Eleven episodes of acute rejection in 11 eyes were treated successfully with steroids.

Positive pressure during penetrating keratoplasty can be solved with a modified graft‐over‐host technique

“…In a larger reported study on parabulbar anaesthesia for PKP, the rate of PP was only 4% of cases, but in this study we have no comparison with patients operated on by general anaesthesia (Agrawal & Tharoor 2002). One of the previously reported disadvantages of the graft‐over‐host technique was cataract formation (Loden & Price 1998). With the MGOH technique we have not seen cataract development among eight cases operated on by this technique in the first two postoperative years.…”

“…There are not much data on the frequency of PP during PKP according to our results it occurs in 3.6% of cases; and because it can lead to a loss of sight, it is important to determine which surgical technique can prevent further intraoperative complications without jeopardizing donor corneal tissue. The so-called 'graft-over-host' technique to overcome PP during PKP had been reported a while ago, when this technique had been used in 33 eyes, of which none had primary graft failure (Loden & Price 1998). A somewhat different approach to overcoming PP was also reported in the eyes of infants and children with low scleral rigidity (Faktorovich & Rabinovitz 1999).…”

“…However, PKP is still being performed by many surgeons, and preventing its serious complications is of interest for every corneal surgeon. Price et al have suggested a so-called graft-over-host technique to solve positive pressure (PP) during PKP (Loden & Price 1998). In this paper, we present a modified graft-over-host (MGOH) technique to resolve PP with iris prolapse during PKP, together with postoperative results of such cases regarding graft survival rate and endothelial cell density (ECD) loss in the first two postoperative years.…”

Incidence, Pathophysiology, Complications, and Management of Positive Vitreous Pressure During Penetrating Keratoplasty: A Literature Review

“…22 Moreover, ensuring adequate akinesia with the peribulbar or retrobulbar deep block using the least volume with supplementary hyaluronidase and external ocular pressure for 30 minutes using Honan’s balloon, rubber ball, or external ocular digital pressure may also be helpful. 4 , 22 At the beginning of surgery, avoiding positioning the patient, particularly obese patients, in the Trendelenburg position to avoid increased thoracic and intraorbital pressure. 20 …”

Nongraft epithelialization after COVID-19 infection in a pediatric penetrating keratoplasty

“…The patient tested negative for COVID-19 infection 2 days prior to surgery. The PKP was performed using the graft-over-host technique[ 4 ] under general anesthesia with no complications. To trephine the recipient cornea, a 7.00-mm vacuum trephine was used and a 7.5-mm donor corneal graft was implanted.…”