Graft-host Junction Research Articles

Evaluation of the Cornea by Anterior Segment Optical Coherence Tomography in Diseases of the Cornea.

The aim of the study was to determine any new findings provided by anterior segment optical coherence tomography (AS-OCT) in different corneal diseases diagnosed by slit lamp examination (SLE). This cross-sectional, observational, hospital-based study was conducted at a tertiary care centre in Western Maharashtra from September 2022 to June 2024, and it included 93 eyes of 93 patients with isolated corneal diseases.A detailed SLE of the anterior segment was done to assess corneal pathology, corneal thickness, corneal structural integrity, presence of corneal opacities, corneal vascularization, presence of other abnormalities like corneal degeneration, corneal foreign bodies, Kayser-Fleischer (KF) ring, ocular surface squamous neoplasia (OSSN). All patients underwent AS-OCT with imaging protocolstailored to each corneal condition, including assessment of focal thinning in Keratoconus patients, graft-host junction integrity in post-keratoplasty cases, Descemet's membrane integrity in post-cataract surgery patients, localization and depth of invasion of corneal foreign bodies, detection of KF rings in Wilson's disease cases, and identifying and assessing extent of corneal dystrophies, corneal degenerations, and OSSN. AS-OCT findings were compared with SLE results to identify any additional information provided by AS-OCT over SLE in the study population.For statistical analysis, data was entered into Microsoft Excel (Microsoft Corporation, Redmond, Washington, United States) and analysed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp; Armonk, New York, United States). Inter-rater agreements between SLE and AS-OCT were evaluated by Cohen's Kappa by using IBM SPSS Statistics for Windows, Version 26.0. AS-OCT enabled additional diagnosis of three (15.8%) more cases of keratoconus, which were declared normal on SLE.AS-OCT identified one (5.90%) case of deep-seated stromal corneal foreign body among the cases which were reported to have only superficial corneal foreign body on SLE. Two (50%) casesof suspected OSSNon SLE were ruled out on AS-OCT, whereas two (50%) casesof suspected OSSNon SLE were confirmed on AS-OCT. AS-OCT found a KF ring among two (12.5%) cases that were reported to have no KF ring on SLE. On both SLE and AS-OCT, 26 (81.2%) cases showed the same findings, whereas in 30 (49.2%) cases, AS-OCT rejected the suggested findings of the SLE. In six (18.8%) cases, SLE did not show any findings, but AS-OCT showed findings. Both SLE and AS-OCT showed no findings in 31 (50.8%) cases. This study highlights the significant role of AS-OCT in enhancing the diagnostic accuracy of various corneal diseases. Its ability to detect additional findings in various corneal conditions such as keratoconus, corneal foreign bodies, OSSN, and KF ring in Wilson's disease underscores its value in clinical practice. The utility of AS-OCT in diagnosing subclinical corneal diseases which are beyond the scope of routine SLE has been demonstrated in our study. These capabilities make AS-OCT an effective additional diagnostic toolin evaluating cornea and should be routinely incorporated along with traditional SLE in evaluating various corneal diseases.

Clinical profile and outcomes of rejection after deep anterior lamellar keratoplasty in keratoconus.

To report the clinical features and management outcomes of rejection after deep anterior lamellar keratoplasty (DALK). The clinical features, indications, predisposing risk factors, management, and outcome of six eyes of six patients with rejection after DALK were analyzed retrospectively. The median time of rejection from the day of surgery was 12 (range 3-36) months. Median duration of symptoms was 4 (range 2-28) days. The indication for DALK was keratoconus in all eyes. The clinical features at presentation included graft haze, vascularization, and melt at the graft-host junction. The risk factors noted were noncompliance to steroids in all eyes, vernal conjunctivitis (four eyes), and eccentric graft (one eye). The rejection episode reversed with topical steroids in all eyes and intravenous methylprednisolone in one eye. One eye developed secondary fungal keratitis after initial recovery and one eye had a second episode of rejection 3 months later, which resulted in progressive vessels and lipid keratopathy in the visual axis. The median best corrected visual acuity was 20/40 (range 20/30-20/200). Severe stromal rejection can present with graft melt. Repeat episodes of rejection can occur on sudden cessation of topical steroids. Prompt recognition of clinical signs and symptoms with timely management helps in quick reversal of the rejection episode. Reversal of graft rejection results in good visual outcomes.

Investigation of mechanical strength and structure of corneal graft-host junction

Dehiscence is a common complication of corneal transplant surgery involving separating the graft from the host eye. The present article aims to investigate fundamental insights into the mechanical and structural aspects of the graft-host junction (GHJ) of a graft that survived in a patient for 13 years after penetrating keratoplasty (PK). Additionally, it adopts the sutur retention strength (SRS) test procedure defined in ISO:7198-2016 and aims to provide a comprehensive test protocol to study the biomechanics of the GHJ in extracted PK buttons. A 9 mm corneal button with GHJ was extracted from a 46-year-old patient who underwent PK 13 years back. The strength of the GHJ was quantified using the SRS test. Corresponding control results were obtained from the SRS tests of a corneoscleral button with no history of any refractive procedure. Birefringence, histological, and scanning electron microscopy (SEM) imaging were used to visualize the microstructural details of the GHJ. The strength of the GHJ was observed to be ten times lower than the native cornea. Histopathological features, such as fragmented Bowman's layer, and fibrosis with a clear demarcation line between host and graft tissue, were observed at the GHJ, suggesting a weak bond across the GHJ. The low strength of the GHJ in PK indicates the high susceptibility of the GHJ towards wound dehiscence.

What Is the Revision-free Survival of Resurfaced Allograft-prosthesis Composites for Proximal Humerus Reconstruction in Children With Bone Tumors?

What Is the Revision-free Survival of Resurfaced Allograft-prosthesis Composites for Proximal Humerus Reconstruction in Children With Bone Tumors?

Intraoperative collagen imaging of sutured cornea: A way towards managing post-penetrating keratoplasty astigmatism

The birefringent nature of the human cornea plays an important role in comprehending its structural behavior in both diseased and surgical conditions. During corneal transplantation, irregular astigmatism is a common post-surgical complication that depends on the characteristics of suturing. Four human cadaver corneas are subjected to an in-vitro model of a typical full-thickness penetrating keratoplasty (PK) procedure using 16 simple interrupted 10–0 vicyrl sutures. The birefringence of these four corneas is analyzed using digital photoelasticity and compared with the control cornea (without PK). It is found that the sutures and their mutual interaction influence the morphology of the peripheral birefringence of the cornea. The findings of the present investigation are pertinent to intraoperative suture management during PK. Results suggest conserving the typical diamond-shaped morphology of peripheral birefringence would ensure uniform distribution of sutures. Therefore, birefringence imaging could be useful in suture management to ensure proper apposition of the graft-host junction, thus minimizing the risk of irregular astigmatism.

Surgical management of complicated Descemet’s membrane detachment in corneas without prior endothelial keratoplasty

PurposeTo provide insights into morphologic and functional features of eyes with complicated Descemet's membrane detachment (DMD) and report clinical outcomes after surgical intervention.MethodsRetrospective study of 18 eyes with complicated DMD between 2010 and 2022. Complicated DMD was defined if any of the following criteria applied: prior penetrating keratoplasty (PKP), corneal thinning, total DMD or persistent DMD after Air/Gas-Descemetopexy. Causes, surgical management, and clinical outcomes were analyzed. Scheimpflug tomography, anterior segment optical coherence tomography (AS-OCT) and histologic examination were performed to characterize corneas with DMD.ResultsFourteen eyes with prior PKP developed spontaneous DMD after 24.2 ± 12.9 years (range = 18 months – 47 years, median = 25.7 years). Complicated DMD without prior PKP was associated in three eyes after cataract surgery and in one eye after infectious keratitis. In cases with previous PKP, AS-OCT demonstrated rupture of Descemet’s membrane (DM) in five eyes and spontaneous reattachment was found in four eyes within 8 weeks of initial diagnosis, with no rupture of DM in any of the cases. There was no rupture of DM in corneas without previous PKP. After prior keratoplasty, definitive surgical treatment was repeat PKP in 13 eyes and Air/Gas-Descemetopexy in one eye. In corneas without prior keratoplasty, three eyes underwent PKP and one eye Air/Gas-Descemetopexy. Histological examination of two corneal explants revealed a severely thinned graft-host junction and a disrupted DM close to the graft-host junction. Visual acuity improved from 1.80 ± 0.58 logMAR to 0.75 ± 0.69 logMAR after prior PKP and from 1.45 ± 0.65 logMAR to 0.85 ± 1.13 logMAR without prior PKP. The postoperative course was uneventful in 16 of 18 eyes.ConclusionPKP is an effective treatment option for complicated DMD, especially in ectatic corneas, whereas Air/Gas-Descemetopexy or Descemet Membrane Endothelial Keratoplasty do not address the primary issue of the curvature anomaly.

Cataract surgery following penetrating keratoplasty in children.

Following penetrating keratoplasty, cataract surgery warrants certain modifications to ensure maximum survival of the graft. To emphasize the intraoperative challenges and surgical manipulations to be followed. The surgeon makes a superior sclerocorneal tunnel avoiding the graft host junction. Dispersive viscoelastic is used. Continuous curvilinear capsulorhexis is done. Cataractous lens aspirated with a low flow rate. The intraocular lens is placed in the bag. Superior peripheral iridectomy and primary posterior capsulorhexis are done. The wound closed with two interrupted 10-0 nylon sutures. Graft host junction integrity is maintained. Ensure 1. Good intraoperative corneal visibility, 2. Avoid graft host junction for main port incision 3. Generous dispersive viscoelastic use/soft shell technique to protect the corneal endothelium, 4. Avoid phaco energy in case of soft cataracts/low phaco energy and flow rates, 5. Phaco probe to be meticulously oriented away from corneal endothelium, 6. Primary posterior capsulorhexis to be done as in any pediatric cataract surgery, 7. Make sure of the graft host junction integrity at the end of the surgery, 8. Restrict to a single port whenever possible. https://youtu.be/tu4R5JangYs.

High Astigmatism Secondary to Peripheral Ectasia Recurrence in Postpenetrating Keratoplasty Eyes Managed With Miniscleral Contact Lenses.

After penetrating keratoplasty (PK) for keratoconus, vision can be impaired by high-degree astigmatism, particularly in those patients with recurrent peripheral ectasia. Scleral contact lenses (CLs) have long been used in the management of keratoconus both in treatment-naive corneas and those postcorneal transplants. We report the use of miniscleral CLs and their related visual and clinical outcomes in a series of patients with post-PK peripheral rim ectasia. In this retrospective case series, 5 patients (7 eyes) presented because of reduced visual acuity with their spectacles/CLs and/or reduced comfort with their existing rigid gas-permeable lenses. All patients in this series underwent PK more than two decades ago for keratoconus (mean 28.7 years±7.2). All patients demonstrated characteristic thinning at the graft-host junction, with anterior chamber deepening. Central corneas had remained clear in all patients inferring high visual potential. Contact lenses used were No 7 Comfort 15 miniscleral and the Onefit MED scleral with 14.5 mm and 15.6 mm diameters, respectively. All eyes achieved a best-corrected visual acuity of 6/9 or greater. One case had difficulty with insertion and removal and has since discontinued wearing lens at this time. All others are successfully wearing the lenses regularly. Despite advances in CL design, surgical management is still required in some patients. Miniscleral CLs are effective in the refractive management of peripheral ectasia in keratoconic post-PK eyes and should be considered in such eyes before proceeding with repeat surgical intervention.

Post-deep anterior lamellar keratoplasty ectasia in a case of macular corneal dystrophy

A 30-year-old female presented with diminution of vision in the right eye for 2 months. She was a known case of macular corneal dystrophy and had undergone OD deep anterior lamellar keratoplasty 2 years back. The best corrected visual acuity (BCVA) was 6/18 at 6 months. At presentation, the BCVA was 4/60 and 6/60 in OD and OS, respectively. The graft was clear with no interface haze. An area of graft ectasia with thinning at the inferotemporal (7–9'o clock) graft–host junction was noted clinically and on tomography. Rigid gas permeable contact lenses showed a BCVA of 6/9 and were advised.

Analysis of visual and refractive results after wedge resection for high astigmatism after penetrating keratoplasty in keratoconus.

To analyze visual and refractive results after wedge resection to correct high astigmatism after penetrating keratoplasty (PK) for keratoconus. Cornea Unit of the Centro de Oftalmología Barraquer Barcelona, Spain. A retrospective quasi-experimental, before and after study. Patients who developed high astigmatism or ectasia in the graft-host junction after PK were treated with wedge resection. The following variables were studied before the surgery, 1-year after and at the final visit: uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive and topographic astigmatism and spherical equivalent. Vectorial analysis of the astigmatism changes was performed. Fifty-one eyes were included with a mean follow-up of 4.19 ± 3.09 years. Mean refractive astigmatism was 11.47 ± 3.57 diopters (D) pre-operatively and 4.79 ± 3.32 D at the final follow-up (p < 0.001). The mean centroid changed from 2.65 ± 11.82 D at 23 degrees preoperatively to 0.35 ± 5.86 D at 127 degrees postoperatively. Concerning spherical equivalent, the mean preoperative value was -3.10 ± 4.15 D and the mean postoperative value was -1.55 ± 3.41 D (p = 0.002). Mean pre-operative and final follow-up UDVA were 1.25 ± 0.27 and 0.84 ± 0.50 (p < 0.001). Mean Pre-op and final follow-up CDVA were 0.27 ± 0.19 and 0.24 ± 0.24. Wedge resection is a useful surgical procedure to correct high astigmatism. It is a safe technique with moderate efficacy and may be considered as initial procedure of choice in high astigmatism due to long-term ectasia in the graft-host junction after PK for keratoconus.

Modified Deep Anterior Lamellar Keratoplasty Technique to Rescue Failed Penetrating Keratoplasty.

To describe a modified deep anterior lamellar keratoplasty (DALK) technique to rescue failed penetrating keratoplasty (PK) grafts and report its results. Retrospective, case-series analysis of patients who underwent modified DALK to rescue failed corneal grafts after PK was included. Every patient had corneal graft failure (GF) diagnosis due to anterior corneal (epithelium, Bowman's, and stroma layers) or refraction disorders uncorrectable with conservative management. The main objective of the surgery and primary outcome of the study was the improvement of corrected distance visual acuity (CDVA). The study's secondary outcome was the frequency of intra- and postoperative complications. This series included four eyes from three patients with a mean age of 57.7 years (range: 51-63 years). Mean follow-up of patients was thirteen months (range: 12-15 months). During follow-up, continuous improvement of corneal transparency and CDVA was observed in every patient. The only intraoperative complication reported was a peripheric DM microperforations of previous graft-host junction in two eyes. No signs of double anterior chamber, endothelial failure, GF, glaucoma, or other side effects were reported. Our results suggest that modified DALK in patients with GF after PK, preserving a healthy endothelium, is surgically feasible. However, further studies are needed to compare this procedure to PK and other DALK technique variations.

A safer alternative approach to penetrating keratoplasty in opaque corneas

Background:This video demonstrates a useful technique of keratoplasty which can be routinely undertaken by all surgeons when imaging modalities such as anterior segment optical coherence tomography are not available and prior patient history is not forthcoming.Purpose:To demonstrate a technique of lamellar separation and layer by layer removal of host cornea when dealing with keratoplasty in perforated corneal ulcers, adherent leucomas, dense corneal opacities, which obscure visualization of the iris and anterior chamber details.Synopsis:In this video, we demonstrate penetrating keratoplasty in a failed opacified graft with iridocorneal adhesions, with no visualization of anterior chamber details. Lamellar dissection of the host cornea is done starting at its periphery and moving centrally, with gentle peeling of the superficial layers, the epithelium and bulk of stroma, following which, the deeper portion of the cornea is dissected and separated from underlying adherent iris tissue. Layer by layer separation allows better visualization through the remaining thin layers of the cornea. This permits fine dissection and layered removal of the cornea, thereby avoiding injury to iris and lens. Debulking of the host cornea decreases the force that is needed to be applied to separate adherent iris tissue from the host cornea, and reduces the chances of sudden entry into the anterior chamber and subsequent damage to the iris or lens. This also reduces the chance of iris tears, iridodialysis and bleeding from the iris and helps maintain iris integrity, which is essential intraoperatively for protection of lens and anterior chamber formation, and to avoid glare and photophobia postoperatively. Preventing iris damage also reduces the chances of formation of peripheral anterior synechiae (PAS), which can predispose to graft rejection, graft failure and secondary glaucoma.Highlights:Layer by layer corneal separation beginning inside the graft host junction, careful separation of iridocorneal adhesions and PAS is a helpful technique to optimally preserve the anterior segment anatomy during difficult cases of penetrating keratoplasty.Online Video Link: https://youtu.be/ZmQQhuOnAh4

Anterior synechiae after penetrating keratoplasty in infants and children with Peters’ anomaly

BackgroundTo evaluate anterior synechiae after penetrating keratoplasty (PK) in patients with Peters’ anomaly using anterior segment optical coherence tomography (OCT).MethodsA retrospective cross-sectional study was performed. The medical records of patients diagnosed with Peters’ anomaly who underwent PK between 2013 and 2018 were reviewed. In addition to basic ophthalmic examinations, images of anterior segment structures were obtained via spectral-domain OCT at baseline and during the postoperative follow-up period. The profiles of postoperative anterior synechiae and multiple potential risk factors were analyzed.ResultsSeventy-one eyes of 58 patients, aged 5 to 23 months, were included. Various extent of postoperative anterior synechiae was observed in 59 eyes (83.1%). OCT findings revealed graft-host junction synechiae, peripheral anterior synechiae, and a combination of both. Disease severity and malposition of the internal graft-host junction were significantly associated with the formation of postoperative synechiae. Multivariate regression analysis found that preexisting iridocorneal adhesion [odds ratio (OR) = 16.639, 95% confidence interval (CI) 1.494–185.294, p = 0.022] was positively correlated with postoperative anterior synechiae, whereas anterior chamber depth (OR = 0.009, 95% CI 0.000–0.360, p = 0.012) and graft size (OR = 0.016, 95% CI 0.000–0.529, p = 0.020) were negatively correlated with postoperative synechiae. In addition, quadrants of preexisting iridocorneal adhesion and width of the host corneal bed were identified as risk factors for increased postoperative anterior synechiae.ConclusionsAnterior synechiae following PK is a relatively common occurrence in Peters’ anomaly patients and is found to be associated with preexisting iridocorneal adhesion, a shallow anterior chamber, small graft size, graft-host junction malposition, and graft closer to the corneal limbus. These data indicate the need for careful consideration when performing PK on these patients.

A 10-Year Retrospective Case Series on Wound Dehiscence Following Corneal Transplant.

Background and objectiveCorneal transplants are associated with multiple well-known complications, one of them being wound dehiscence. It results in unfavorable outcomes, such as ocular structure damage, graft failure, repeated surgeries, and possibly a poor prognosis in terms of vision quality. Although the wound site may appear well-healed clinically, as the strength at the graft-host junction is weak, the site is susceptible to dehiscence. Wound dehiscence can be secondary to suture removal and/or trauma. In this study, we assessed the incidence of wound dehiscence secondary to trauma following corneal transplant and evaluated its occurrence in terms of patient age, type of corneal transplant performed, duration between corneal transplantation and wound dehiscence, mechanism of injury, and final outcome.MethodsThis was a case series that included all patients who suffered from wound dehiscence secondary to trauma post-corneal transplant between January 1, 2009, and December 31, 2019, at Hospital Kuala Lumpur.ResultsA total of 492 patients underwent corneal transplant surgery during the 10-year study period. Based on specified inclusion and exclusion criteria, only 13 patients were eligible for inclusion in this study. The incidence of wound dehiscence secondary to trauma post-penetrating keratoplasty (PK) was low (2.64%). Twelve patients had undergone PK, while one patient had undergone deep anterior lamellar keratoplasty (DALK). Blunt ocular trauma post-transplant can cause wound dehiscence regardless of patient age and duration post-corneal transplantation. Males are at a higher risk as their active lifestyle contributes to higher exposure to ocular injury.ConclusionAs corneal transplant patients are at life-long risk of wound dehiscence post-transplant, they must be counseled about this possible risk and the need to take adequate precautions in their daily lives. Based on our findings, the use of newer technologies and partial- rather than full-thickness corneal transplants should be explored further.

Bevacizumab in High-Risk Corneal Transplantation: A Pilot Multicenter Prospective Randomized Control Trial

To determine the efficacy of local (subconjunctival and topical) bevacizumab (Avastin) treatment in patients undergoing vascularized high-risk corneal transplantation. Pilot, prospective, randomized, double-blind, placebo-controlled clinical trial conducted at 5 clinical centers in the United States, India, and Brazil. Patients aged > 18 years undergoing high-risk penetrating keratoplasty, defined as corneal neovascularization (NV) in 1 or more quadrants ≥2 mm from the limbus or extension of corneal NV to the graft-host junction in a previously failed graft. Patients were randomized to receive subconjunctival bevacizumab (2.5 mg/0.1 ml) or placebo at the time of surgery, followed by topical bevacizumab (10 mg/ml) or topical placebo, administered 4 times per day for 4 weeks. The 52-week endothelial immune rejection rate. Ninety-two patients were randomized to receive bevacizumab (n= 48) or control (n= 44). The 52-week endothelial rejection rate was 10% in the bevacizumab group and 19% in the control group (P= 0.20). Post hoc, extended follow-up at the lead study site showed an endothelial rejection rate of 3% in the bevacizumab group and 38% in the control group (P= 0.003). Treatment with bevacizumab was found to have a hazard ratio of 0.15 (95% confidence interval, 0.03-0.65, P= 0.01) in a post hoc Cox regression analysis. In patients undergoing vascularized high-risk corneal transplantation, there was no statistically significant difference in the rate of endothelial rejection at 1 year in the bevacizumab treatment group compared with the control group. This study may have been underpowered to detect a difference between treatment groups, and taken together, our data suggest that, in the current trial design, bevacizumab has a positive but not (yet) significant effect on endothelial rejection.

Anterior segment optical coherence tomography findings after penetrating keratoplasty

AbstractPurposeThis study aimed to assess the contribution of early anterior segment optical coherence tomography (AS‐OCT) after penetrating keratoplasty (PK) by analyzing the appositions of posterior graft‐host junction (GHJ), the tomographic aspect of the graft and the iridocorneal angle (ICA).MethodsA prospective cross‐sectional study including 33 eyes of 32 patients treated with penetrating keratoplasty for various preoperative diagnosis (hydrops, keratoconus, bullous keratopathy, infectious keratitis, ocular trauma, corneal perforation, corneal dystrophy and graft failure). All patients underwent complete ophthalmic examination. Early AS‐OCT (Day 1‐10 postoperative) was done to assess the posterior GHJ, the central corneal thickness, the posterior graft corrugations and the ICA. GHJ patterns were classified as well‐apposed, and mal‐apposed (gap, step, and protrusion). Tomographic features were correlated to best‐corrected visual acuity, and postoperative complications.ResultsThe mean early postoperative central corneal thickness was 643.63 μm. Posterior corrugations were found in 47% of cases, in patients with graft thickness higher than 590 μm. ICA was open except in 4 eyes, among them, two eyes presented anterior synechia, and developed ocular hypertension and graft rejection. A total of 132 graft‐ host cross‐sections were analyzed. 67% were well‐apposed and 33% were mal‐apposed. Steps have been noted in 8 eyes, followed by Gapes in 3 eyes, and Protrusion in 2 cases. Graft‐steps were present in 4 GHJ and all of these patients had keratoconus as a preoperative diagnosis. Among them, one eye underwent surgical revision for persistent graft edema. Host‐steps were detected in 4 mal‐apposed junctions. Best‐corrected visual acuity showed significant difference with the gap and step patterns of malapposition junctions.ConclusionsAS‐OCT is a non‐invasive imaging tool offering high‐resolution corneal imaging. It visualizes the posterior GHJ and ICA beyond a non‐transparent cornea. It is useful for evaluating and monitoring the PK outcomes allowing early detection and management of postoperative complications.

Outcome Analysis of En bloc Resection and Reconstruction by Non-vascularized Proximal Fibular Autograft in Giant Cell Tumor of Distal Radius supplemented with Brachytherapy.

Giant cell tumors of the bone are aggressive and potentially malignant lesions. Juxtaarticular giant cell tumors of the lower end radius are common and is a challenge for reconstruction after tumor excision. Several reconstructive procedures like vascularized and non-vascularized fibular graft, osteoarticular allograft, ceramic prosthesis, and megapros thesis are in use for substitution of the defect in the distal radius following resection. Here, we have analyzed the results of aggressive benign Giant cell tumor of the distal radius treated by en bloc excision and reconstruction using autogenous non-vascularized fibular graft along with brachytherapy. Eleven patients with either Campanacci Grade II or III histologically proven giant cell tumors of lower end radius were treated with en bloc excision and reconstruction with ipsilateral non-vascularized proximal fibular autograft. Host graft junction was fixed with low contact dynamic compression plate (LC-DCP) in all cases. Fixation of the head of the fibula with carpal bones and distal end of the ulna, if not resected, using K-wires at graft host junction was done. Brachytherapy was given in all 11 cases. Routine radiographs and clinical assessments regarding pain, instability, recurrence, hand grip strength, and functional status were done using Mayo modified wrist score at regular intervals. The follow-up ranged from 12 to 15 months. At last follow-up, the average combined range of motion was 76.1%. The average union time was 19 weeks. Out of 11 patients, two patients had good results, five patients had fair results, and four patient had poor results. There was no case of graft fracture, metastasis, death, local recurrence, or significant donor site morbidity. En bloc resection of giant cell tumors of the lower end radius is a widely accepted method. Reconstruction with non-vascularized fibular graft and internal fixation with LC-DCP along with brachytherapy minimizes the problem and gives satisfactory functional results with no recurrence.

Late-onset spontaneous Descemet's membrane detachment in penetrating keratoplasty - A case report

We present a case of acute graft edema due to late-onset Descemet's membrane detachment (DMD) in a penetrating keratoplasty done two decades ago for keratoconus. A 48-year-old male presented with defective vision and redness in the right eye. The absence of the anterior chamber (AC) inflammation, keratitic precipitates, and the presence of glistening reflex in the AC, with a double contour along the inferotemporal graft host junction, suggested an acute hydrops in the graft. An anterior segment optical coherence tomography (ASOCT) confirmed DMD with the absence of an obvious tear. In the region of the double contour, a lamellar flap/fold of DM beyond the graft host junction (GHJ) but within the detachment and stroma was noted. Descemetopexy with intracameral sulfur hexafluoride gas and compression sutures along the region of the double contour restored graft clarity and vision. A DMD should be considered as a possible cause of acute edema and can be often misdiagnosed as graft rejection.

Post-traumatic isolated host bed dehiscence with an intact limbal sparing lamellar keratoplasty graft-host junction

Post-traumatic isolated host bed dehiscence with an intact limbal sparing lamellar keratoplasty graft-host junction

CORR Insights®: Does Local Zoledronate Applied to Pasteurized Bone Autografts Improve the Likelihood of Union of Graft-Host Junctions after Limb-sparing Surgery?

CORR Insights®: Does Local Zoledronate Applied to Pasteurized Bone Autografts Improve the Likelihood of Union of Graft-Host Junctions after Limb-sparing Surgery?