Outcomes of staged conjunctival flap and corneal transplantation for infectious keratitis resistant to medical treatment.

Autor:	Kilian R; Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy.; Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy., Pellegrini M; Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy.; Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy., Yu AC; Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy.; Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy., de Ruvo V; Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy drvvnt@unife.it.; Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy., Salgari N; Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy.; Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy., Busin M; Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy.; Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy.
Jazyk:	angličtina
Zdroj:	The British journal of ophthalmology [Br J Ophthalmol] 2024 Dec 06. Date of Electronic Publication: 2024 Dec 06.
DOI:	10.1136/bjo-2024-326225
Abstrakt:	Background/aims: To explore the outcomes of conjunctival flap (CF) followed by keratoplasty in patients with severe infectious keratitis (IK) unresponsive to medical treatment. Methods: This is a retrospective monocentric study including 29 eyes of 29 patients with IK resistant to antibiotic treatment associated with stromal ulcer deepening to ≥50% of corneal thickness. All eyes underwent Gundersen's CF procedure and penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK) or mushroom keratoplasty (MK), at least 4 months thereafter. Outcome measures included corrected distance visual acuity (CDVA), endothelial cell count (ECC), graft survival and complications. Results: IK healed in all eyes following CF. The mean time interval between CF and keratoplasty was 16.3±16.1 months. 55% of patients underwent PK, 35% MK and 10% DALK. Mean follow-up duration was 39.6±34.3 months. At the last available follow-up, a CDVA≥20/200 was obtained in 50%, 33.3% and 70% of cases, respectively after PK, DALK and MK. Mean annual endothelial cell loss was 24.5% following PK and 10.7% following MK. Overall, graft failure occurred in 75% of cases after PK, 100% after DALK and 20% after MK. The most frequent complications were endothelial decompensation without immunological rejection (34.5%, after 31.1±25.1 months) and graft rejection (17.2%, after 10.2±7.9 months, all in the PK group). Conclusion: CF surgery followed by staged keratoplasty represents an alternative therapeutic approach to avoid high-risk keratoplasty 'a chaud' in cases of severe IK. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu