Sclerokeratitis after Keratoplasty in Atopy

Lyons, Christopher J.; Dart, John; Aclimandos, Wagih; Lightman, Susan; Buckley, Roger

doi:10.1016/s0161-6420(90)32523-x

Cited by 40 publications

(19 citation statements)

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“…However, if treated early with high dose oral prednisolone, in many patients the inflammation can be controlled quickly and the prognosis is good with no recurrences. 2 We describe three cases in which oral steroids did not control the inflammation and cyclosporin was added with rapid improvement. Although therapy over many months was required, both drugs were eventually stopped.…”

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confidence: 95%

“…1 Intense inflammation can occur shortly after surgery resulting in wound dehiscence, failure of epithelialisation, and early rejection called post-keratoplasty atopic sclerokeratitis (PKAS). 2 This condition occurs uncommonly particularly in atopic individuals with high (>1000 IU/ml) serum IgE. They present up to 10 days postoperatively with severe photophobia, pain, epiphora, mucus discharge, intense conjunctival and anterior scleral injection with mucus adherent to the sutures which can cheesewire through the inflamed tissues leading to wound slippage and frank dehiscence.…”

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confidence: 99%

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Use of cyclosporin in the treatment of steroid resistant post-keratoplasty atopic sclerokeratitis

Daniell

Dart²,

Lightman³

2001

British Journal of Ophthalmology

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Aims-To demonstrate that oral cyclosporin is successful in the management of steroid refractory post-keratoplasty atopic sclerokeratitis (PKAS). Methods-Series of three patients.Results-The patients developed PKAS between 2 and 11 days after surgery. All cases failed to respond to oral prednisolone 60-80 mg daily for 10-30 days but resolved with the addition of systemic cyclosporin 5.0-7.5 mg/kg/day. There have been no relapses following withdrawal of therapy after 3-18 months. Conclusions-PKAS is an uncommon, but severe, complication of corneal graft surgery and often responds to oral prednisolone treatment. Oral cyclosporin results in rapid resolution of PKAS in steroid unresponsive cases. (Br J Ophthalmol 2001;85:91-92) Penetrating keratoplasty may be required to treat keratoconus and corneal scarring associated with atopy related eye diseases.1 Intense inflammation can occur shortly after surgery resulting in wound dehiscence, failure of epithelialisation, and early rejection called post-keratoplasty atopic sclerokeratitis (PKAS).2 This condition occurs uncommonly particularly in atopic individuals with high (>1000 IU/ml) serum IgE. They present up to 10 days postoperatively with severe photophobia, pain, epiphora, mucus discharge, intense conjunctival and anterior scleral injection with mucus adherent to the sutures which can cheesewire through the inflamed tissues leading to wound slippage and frank dehiscence. Later, microbial keratitis and graft rejection supervene. However, if treated early with high dose oral prednisolone, in many patients the inflammation can be controlled quickly and the prognosis is good with no recurrences. 2 We describe three cases in which oral steroids did not control the inflammation and cyclosporin was added with rapid improvement. Although therapy over many months was required, both drugs were eventually stopped. Case reports CASE 1This 25 year old man with previous vernal keratoconjunctivitis had keratoconus diagnosed at the age of 9. At surgery the best corrected left acuity was 6/12 and 6/120 right with a cone too steep for contact lens fitting. His serum IgE was 120 IU/l preoperatively. A right (8 mm) penetrating keratoplasty was performed using 16 interrupted sutures and subconjunctival betnesol at the end of surgery.The day after surgery there was minimal inflammation but at 4 days postoperatively, he developed acute inflammation, photophobia, and pain in the right eye and was diagnosed as having PKAS. Dexamethasone eye drops 0.1% were increased to hourly and prednisolone 80 mg daily was added. After 8 days (day 15 postoperatively), there was less pain but severe inflammation remained with anterior scleritis and infiltrates at the host insertion of some sutures. Oral cyclosporin (Sandimmun, Novartis), was added at 5 mg/kg/day. The inflammation completely resolved over the subsequent 12 days (by 27 days postoperatively) and the prednisolone was reduced over the following 3 months when it was stopped, followed by the cyclosporin. Two loose corneal sutures were...

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confidence: 95%

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confidence: 99%

Use of cyclosporin in the treatment of steroid resistant post-keratoplasty atopic sclerokeratitis

Daniell

Dart²,

Lightman³

2001

British Journal of Ophthalmology

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“…This IgE may adhere to the PMMA inserts and initiate a cascade of inflammatory destruction. 19 The absence of sutured entry sites and wound gape with the Ferrara freehand technique combined with the proximal location of the ICRS to the wound may have allowed IgE to bind to the ''exposed'' PMMA, beginning an aberrant, severe, and self-perpetuating inflammatory cascade.…”

Section: Discussionmentioning

confidence: 99%

Keratitis after intracorneal ring segment insertion for keratoconus

McAlister

Ardjomand²,

Ilari³

et al. 2006

Journal of Cataract and Refractive Surgery

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We report a case of sterile keratitis after Ferrara intracorneal ring (Ferrara Ophthalmics) implantation into the right cornea of a keratoconus patient who also suffered from atopic blepharoconjunctivitis. The keratitis resolved within a few days after removal of the Ferrara rings. Ocular atopy with sterile keratitis should be considered in the differential diagnosis of keratitis after the insertion of intracorneal ring segments, which can be easily treated by ring removal.

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“…To date, it appears that the long-term survival of PKP is uncertain, owing to increasing risks of graft rejection, non-rejection related failures and/or recurrent surface disorder, whenever PKP is performed with or without LSCT [139,140]. Unfortunately, the existing clinical series that discuss corneal grafts and/or LSCT are, in general, small and have varying degrees of follow-up [15,61,102,112,[141][142][143][144][145][146][147][148][149][150][151][152][153][154][155]. This limits our ability to draw any valid conclusions from these studies about which surgical technique of LSCT and immunosuppressive therapy are optimal.…”

Section: Perform Corneal Transplantation With or Without Limbal Stem mentioning

confidence: 99%

Graft failure: II. Ocular surface complications

Al-Swailem

2007

Int Ophthalmol

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Risk factors for corneal transplantation failure include both immunologic factors, such as graft rejection, corneal neovascularization, and peripheral anterior synechiae, as well as non-immunologic factors, such as ocular surface disorders (OSD) and glaucoma. This review highlights the necessity of having healthy ocular surface epithelia, tears, and eyelids. It presents different types of OSD, their underlying pathology, and their impact on native cornea and corneal grafts. In addition, a range of proposed donor and surgical factors influencing surface integrity following corneal transplant are addressed. Current medical and surgical research, both pre- and post-operative that promise to further improve the outcome of corneal grafts in the context of OSD are discussed.

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Sclerokeratitis after Keratoplasty in Atopy

Cited by 40 publications

References 7 publications

Use of cyclosporin in the treatment of steroid resistant post-keratoplasty atopic sclerokeratitis

Use of cyclosporin in the treatment of steroid resistant post-keratoplasty atopic sclerokeratitis

Keratitis after intracorneal ring segment insertion for keratoconus

Graft failure: II. Ocular surface complications

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