Keratitis outlook may improve with LDPK
Large-diameter penetrating keratoplasty for infectious keratitis may warrant a more prominent place in the treatment paradigm, suggest results of a retrospective chart review.
Take-home message: Large-diameter penetrating keratoplasty for infectious keratitis may warrant a more prominent place in the treatment paradigm, suggest results of a retrospective chart review.
By Nancy Groves; Reviewed by Danielle Trief, MD
New York-Large-diameter penetrating keratoplasty (LDPK) is usually considered a “last resort” procedure for patients with
However, the procedure can have favorable long-term visual outcomes and should be a more frequently suggested option, indicate results from a recent retrospective chart review.
“[More than] 70% of our patients ultimately had clear grafts, 85% had structural integrity, and 71% had improvement in their visual acuity,” said Danielle Trief, MD. “Those results are encouraging, but physicians should know that half of the patients required a repeat transplant, so it does take a lot of time and effort and maybe more surgery to get to that endpoint.”
Physicians should also be aware that, in this review, prognostic indicators of better outcomes included better preoperative visual acuity and infectious etiology.
Outcomes analysis
Investigators at the New York Eye and Ear Infirmary, where Dr. Trief was a cornea fellow, reviewed records of all eyes with culture-proven infectious keratitis that underwent LDPK (defined as 10 mm or greater) at the facility from January 2004 to December 2014. The analysis included 41 eyes of 41 patients. Outcome measures were visual acuity (converted to LogMAR), complications, and graft failure rates, and all patients had at least 3 months of follow up.
The surgical technique for all patients was similar to that of regular penetrating keratoplasties but with modifications, including a conjunctival peritomy, a hand-held trephine, and excision 0.5 to 1 mm outside of the infected tissue. At least 16 interrupted sutures using 9-0 or 10-0 nylon were used to strengthen the wound integrity. If a cataract was present, it was not removed at the time of surgery unless the capsule was violated.
Internal server error