Cornea - ARVO

ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Corneaby measuring the area of NV, the level of opacification and thecornea thickness. The area of NV from the limbus into the graft wasmeasured by using corneal fluorescein angiography (FA) and digitalmeasurements. Persistence of opacification was assessed by slit-lampmicroscopy and graded on a 0 to 4+ scale. Cornea thickness andcornea astigmatism was measured by ocular coherence topography(OCT). At sacrifice (day 28) the cornea was fixed for histologicalanalysis of neovascularization, inflammation, and rejection.Results: Corneal neovascularization, opacification, cornea thicknesswas significantly higher in the interrupted suture group compared tothe continuous suture group. (p = 0.006 or less). All corneas in thecontinuous suture group exhibited minimal neovascularization andgenerally presented with ≤ 1 opacification at each time point studied.A single running suture results in less postoperative astigmatismcompared with the interrupted sutures technique.Conclusions: Corneas within the interrupted suture group wereassociated with a significant increased level of neovascularization,opacification and astigmatism followed by a higher rate of rejection.The suturing method appears to be a factor leading to the rate ofcornea rejection in a rabbit PK model and may be correlated tohuman surgical outcomes.Commercial Relationships: Maria A. Parker, None; Trevor J.McFarland, None; Winston Chamberlain, None; Scott Ellis,Oxford BioMedica (E); Kyriacos Mitrophanous, Oxford BioMedica(UK) Ltd (E); Tim Stout, Clayton Foundation (P), OxfordBiomedica (C), AGTC (F), Peregrine Pharmaceuticals Inc (C), StemCells Inc (C)Program Number: 3072 Poster Board Number: D0007Presentation Time: 8:30 AM - 10:15 AMMost frequent indications for keratoplasty at 2 academic centersover a 6-year periodKimberly Hsu 1 , Shu-Hong Chang 4, 1 , Whitney Brothers 2 , Sean L.Edelstein 2 , Hugo Y. Hsu 3, 2 , George J. Harocopos 1 . 1 Ophthalmology,Washington University in St. Louis, St. Louis, MO; 2 Ophthalmology,Saint Louis University, St. Louis, MO; 3 Ophthalmology, Universityof Southern California, Los Angeles, CA; 4 Ophthalmology,University of Washington, Seattle, WA.Purpose: To determine the most frequent indications for keratoplastyfrom 2002-2007 at 2 academic centers and to compare this data to themost common indications for keratoplasty nation-wide over this sametime period.Methods: A retrospective review was performed for the indicationsfor keratoplasty from 2002-2007 at Washington University in St.Louis (WUSTL) and St. Louis University (SLU). A pathologydatabase search was used to find all pathology reports of keratoplastyspecimens. The patients’ age, sex, right or left eye, type ofkeratoplasty, indication for keratoplasty, and ocular comorbiditieswere recorded. A total of 855 and 110 eyes underwent keratoplasty atWUSTL and SLU, respectively, during this time period. Statisticalreports were obtained from the Eye Bank Association of America(EBAA) for the corresponding years 2002-2007. The indications forkeratoplasty were reviewed and averaged for these 6 years andcompared to the data from our academic centers.Results: At WUSTL, the most common indication for keratoplastywas graft failure at 31.6%. This was followed by Fuchs cornealdystrophy at 22.1%, pseudophakic and aphakic bullous keratopathy at17.6%, and keratoconus at 6.9%. At SLU, the most commonindications for keratoplasty were PBK/ABK at 34.4% and graftfailure at 32.7%. This was followed by Fuchs corneal dystrophy(10%) and keratoconus (6.4%). Averaging the 2002-2007 EBAAdata, the most common indication for keratoplasty nation-wide wasPBK/ABK at 19.9%. This was followed by keratoconus at 15.9% andthen Fuchs dystrophy at 13.3%. Re-grafts accounted for only 13.2%of keratoplasties performed during this time period nation-wide.Conclusions: In our review of the indications for keratoplasties attwo academic centers in St. Louis, we found re-grafts to account forapproximately one third of all keratoplasties, which was more thandouble the proportion in the national data during this time period. Wepostulate that these higher percentages for re-grafting represent areferral bias of complex patients to academic centers who ultimatelyrequire multiple keratoplasties.Commercial Relationships: Kimberly Hsu, None; Shu-HongChang, None; Whitney Brothers, None; Sean L. Edelstein, None;Hugo Y. Hsu, Bausch & Lomb (R); George J. Harocopos, NoneProgram Number: 3073 Poster Board Number: D0008Presentation Time: 8:30 AM - 10:15 AMOutcome of Combined Penetrating Keratoplasty andVitreoretinal Surgery using Temporary EckardtKeratoprosthesis and Analysis for Factors affecting CornealAllograft SurvivalDae Seung Lee 1 , Jang won Heo 1 , Mee Kum Kim 1 , Hyuk Jin Choi 2 ,Won Ryang Wee 1 , Joo Youn Oh 1 . 1 Ophthalmology, Seoul NationalUniversity, Seoul, Republic of Korea; 2 Seoul National UniversityHospital Healthcare System Gangnam Center, Seoul, Republic ofKorea.Purpose: To evaluate the outcome of combined penetratingkeratoplasty and vitreoretinal surgery using temporary Eckardtkeratoprosthesis and to analyze the factors affecting the cornealallograft survival.Methods: We reviewed medical records of 11 patients whounderwent combined corneal allotransplantation and pars planavitrectomy using temporary Eckardt keratoprosthesis. Primaryoutcome measure was the survival rate of corneal grafts. Patientdemographics, clinical features of the cornea and retina such asdisease entities and preoperative status, or surgical methods werecompared between the group with graft rejection and the group withgraft survival.Results: The overall graft survival rate was 45.5 % (5/11 eyes).Retinal surgery was successful in 90.9 % (10/11 eyes). Rejectionoccurred in 5 patients (45.5 %, 5/11 eyes) with the mean survivaltime of 82.8 days during a follow up of 579 days. Four of 5 cases hadthe graft rejection within 2 months after surgery, and one patient hadrejection at 7 months. The presence of inflammation orvascularization in the cornea before surgery was a significant factoraffecting the occurrence of graft rejection (p value = 0.006). Activeinflammation was present preoperatively in the recipient cornea in allpatients with rejection. Corneal neovascularization was present in therecipient cornea in 4 of 5 patients with rejection. In contrast, therewas no inflammation or vascularization in patients without rejection.The patient age, the presence of glaucoma, entities of corneal andretinal diseases, types of retinal surgery including the use of siliconeoil or gas tamponade had no significant correlation with the graftsurvival or rejection.Conclusions: Combined corneal allotransplantation and pars planavitrectomy using temporary Eckardt keratoprosthesis allowed forsuccessful surgical intervention of retinal diseases in patients withcoexisting corneal opacity. Although the retinal outcome wasexcellent in 90.9 %, corneal allografts survived in 45.5%, largelydepending on the preoperative status of the cornea including thepresence of active inflammation or vascularization.Commercial Relationships: Dae Seung Lee, None; Jang won Heo,None; Mee Kum Kim, None; Hyuk Jin Choi, None; Won RyangWee, None; Joo Youn Oh, NoneSupport: None in the Support field below©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permissionto reproduce any abstract, contact the ARVO Office at arvo@arvo.org.