Oversized corneal grafts for corneal opacities with iridocorneal adhesions

Abstract

Objective To evaluate the efficacy of 1-mm oversized corneal grafts in patients with acquired corneal opacities and extensive peripheral iridocorneal adhesions. Design Prospective noncomparative case series. Participants Twenty patients (20 eyes) aged 15 years or older with unilateral or bilateral corneal opacification and a shallow anterior chamber. Intervention Penetrating keratoplasty was performed with donor corneal buttons oversized by 1 mm. Main outcome measures The various parameters evaluated were visual acuity, graft clarity, keratometry, anterior chamber depth, intraocular pressure, and spherical equivalent refraction 12 months after surgery. Results The keratoplasties were performed in 15 eyes with a corneo-iridic scar after infectious keratitis (75%) and 5 eyes with failed graft (25%). At the final follow-up, a clear graft was achieved in 17 eyes (85%), and 14 eyes (70%) achieved a best-corrected visual acuity of 6/12 or better. Three of the grafts failed because of rejection. The average keratometry was 44.1 ± 1.0 diopters (D), and the mean spherical equivalent was −3.23 ± 2.86 D. The oversized grafts provided a mean anterior chamber depth of 2.36 ± 0.42 mm, and the mean intraocular pressure at the 12 month follow-up was 16.38 ± 2.09 mmHg. Conclusions Corneal grafts oversized by 1 mm provide adequate anterior chamber depth and reduce the risk of peripheral anterior synechiae and secondary glaucoma in patients with corneal opacities and extensive peripheral iridocorneal adhesions.