Persistent epithelial defects in repeated corneal transplants

In instances of repeated corneal transplantation, ulcers and persistent epithelial defects are relatively commonplace, according to a study published in the August 2008 issue of Graefe’s Archive for Clinical and Experimental Ophthalmology.

Shimon Rumelt, MD of the department of ophthalmology, Western Galilee-Nahariya Medical Center, Israel and colleagues conducted a retrospective review of patients (n=80) undergoing multiple corneal transplants and regrafts (n=122) between 1985 and 1998, to evaluate complications at a minimum of six, and an average of 31.5, months after the final surgery.

Of the regrafts, 18 were affected by persistent epithelial defects; five had ulcers; and eight had a combination of both persistent epithelial defects and ulcers. Persistent epithelial defects were more likely following cyclocryotherapy for refractory glaucoma. Nine of the 31 regrafts suffering these complications were also positive for bacterial cultures. The graft survival rate was lower in subjects with repeated epithelial defects complicated by ulcers than in any other group, which all had similar levels of graft survival. Of all patients, 10 suffered at least one eyelid abnormality and ocular surface disorder; this was more likely in patients with epithelial defects and/or ulcers than in patients who did not suffer these complications.

Although these complications are common occurrences followed repeated keratoplasties and are associated with low graft survival rates, predisposing factors can be treated.