Aniridia associated keratopathy leads to corneal opacities, scarring and vascularisation due to a unique form of limbal stem cell deficiency. Persisting epithelial defects, suture loosening and an increased risk of graft rejection are typical postoperative complications in high risk keratoplasty such as in congenital aniridia. We hypothesized that the combination of a small corneal graft size, interrupted sutures, simultaneous amniotic membrane transplantation as a patch, large bandage contact lens, temporary lateral tarsorrhaphy, postoperative autologous serum eye drops, and systemic immunosuppression can reduce the risk of those complications.
Name
La transplantation simultanée de membrane amniotique, la tarsorraphie latérale temporaire et les collyres de sérum autologue améliorent les résultats des kératoplasties transfixiantes dans les kératopathies associées aux aniridies congénitales
Name
La transplantation simultanée de membrane amniotique, la tarsorraphie latérale temporaire et les collyres de sérum autologue améliorent les résultats des kératoplasties transfixiantes dans les kératopathies associées aux aniridies congénitales
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Résumé
Introduction
Patients et Methodes
Between 2012 and 2018, twenty keratoplasties were performed in 13 patients with congenital aniridia at our Department of Ophthalmology – in 2 eyes as a triple procedure. Visual acuity and intraocular pressure before and after keratoplasty, corneal graft size, suture technique (interrupted or double running), use of amniotic membrane transplantation and serum eye drops, size of bandage contact lens as well as morphological and functional status during follow-up were analyzed retrospectively.
Résultats
Six keratoplasties were performed using continuous double running suture, 14 using interrupted sutures. Amniotic membrane transplantation as a patch with a 17mm bandage contact lens was applied 18 times to promote postoperative corneal wound healing. In 10 cases, a simultaneous temporary lateral tarsorrhaphy was performed to support corneal wound closure.
At 6 weeks follow-up, the epithelium was closed in 19 eyes, only one patient needed a second amniotic membrane transplantation due to persisting epithelial defect. 18 eyes received postoperative serum eye drops. All patients received systemic immunosuppression (Ciclosporin or Mycophenolat mofetile). Visual acuity improved in 14 eyes at 6 months follow-up, in 6 eyes visual acuity remained stable, no eye showed a decrease in visual acuity. While the ten eyes that received the complete modified keratoplasty scheme showed no epithelial defect at 6 weeks follow-up and had no corneal complications until one year postoperatively, persistent epithelial defect, graft rejection or suture insufficiency happened exclusively to the other half that was missing at least one of the suggested modifications (p< 0.05).
Discussion
Congenital aniridia is a challenge not only for the corneal surgeon. Keratoplasty in congenital aniridia must be considered a high risk keratoplasty. Since those patients have a very limited visual acuity in the first place due to pathology other than the cornea, complications should be avoided by any efforts necessary.
Conclusion
A modified keratoplasty scheme combining a small corneal graft size, interrupted sutures, simultaneous amniotic membrane transplantation, large bandage contact lens, temporary lateral tarsorrhaphy, postoperative autologous serum eye drops, and systemic immunosuppression seems to be appropriate to reduce the postoperative complication.