the s. fyodorov eye microsurgery state institution, moscow, russia,
DESCRIPTION
The S. Fyodorov EYE MICROSURGERY STATE INSTITUTION, Moscow, Russia,. Moscow. Ekaterinburg. S-Petersburg. Tambov. Novosibirsk. Kaluga. Cheboksary. Orenburg. Irkutsk. Khabarovsk. Volgograd. Krasnodar. ASCRS/ ASOA SYMPOSIUM ON CATARACT, IOL AND REFRACTIVE SURGERY - PowerPoint PPT PresentationTRANSCRIPT
The S. Fyodorov EYE MICROSURGERY STATE INSTITUTION, Moscow,
Russia,
MoscowMoscow
KhabarovskKhabarovskIrkutskIrkutsk
NovosibirskNovosibirsk
OrenburgOrenburg
EkaterinburgEkaterinburg
CheboksaryCheboksary
S-PetersburgS-Petersburg
KrasnodarKrasnodar
VolgogradVolgograd
KalugaKaluga
TambovTambov
ASCRS/ ASOASYMPOSIUM ON CATARACT, IOL AND REFRACTIVE
SURGERY San Francisco, California
April 3–8, 2009
Long-term Graft Survival after Primary Penetrating Low- Risk
Keratoplasty
Olga Kravchuk, M.D., Ph.D.
professor Valentina Kopayeva, M.D., Ph.D., Dr. Med. Sc.
ASCRS/ ASOASYMPOSIUM ON CATARACT, IOL
AND REFRACTIVE SURGERY San Francisco, California
April 3–8, 2009 Financial interest disclosure: NoneFinancial interest disclosure: None
Purpose of the study
To report long – term graft survival rates for penetrating keratoplasty (PKP)
ASCRS/ ASOASYMPOSIUM ON CATARACT, IOL
AND REFRACTIVE SURGERY San Francisco, California
April 3–8, 2009
Materials/ Methods
Retrospective, noncomparative case series Review of 272 consecutive eyes that underwent PKP at a final referral
center in Russian Federation since 1975 Data collected retrospectively from May 1975 through November
1988 and prospectively thereafter
ASCRS/ ASOASYMPOSIUM ON CATARACT, IOL
AND REFRACTIVE SURGERY San Francisco, California
April 3–8, 2009
Materials/ Methods Inclusion criteria: the underlying pathology - keratoconus (82
eyes, 30 %), post inflammatory disease (92 eyes, 33 %), pseudophakic bullous keratopathy (63 eyes, 23 %) and dystrophies (35 eyes, 14 %). Only primary low-risk grafts were included in the trial
All patients underwent penetrating keratoplasty To reduce postoperative astigmatism patented graft marking
method (V. Kopayeva, 1982) was incorporated with disc diameter 7.0- 9.0 mm.
ASCRS/ ASOASYMPOSIUM ON CATARACT, IOL AND
REFRACTIVE SURGERY San Francisco, California
April 3–8, 2009
ASCRS/ ASOASYMPOSIUM ON CATARACT, IOL AND
REFRACTIVE SURGERY San Francisco, California
April 3–8, 2009
Graft marking method surgical steps (V. Kopayeva, 1982) 1
Transparent template application
on recipient cornea.
Determination of the cornea center
Marking of the cornea center
Application of the marker deviceASCRS/ ASOA
SYMPOSIUM ON CATARACT, IOL AND REFRACTIVE SURGERY San Francisco, California
April 3–8, 2009
ASCRS/ ASOASYMPOSIUM ON CATARACT, IOL AND REFRACTIVE SURGERY
San Francisco, California April 3–8, 2009
Graft marking method surgical steps(V. Kopayeva, 1982) 2
Marking of the trephination zone and of four main meridians on the recipient cornea
Setting of the trephine on the marked trephination zone and checking of the correct setting as judged by the adjustment of the marks on the trephine and the cornea
Recipient disc removalASCRS/ ASOA
SYMPOSIUM ON CATARACT, IOL AND REFRACTIVE SURGERY San Francisco, California
April 3–8, 2009
ASCRS/ ASOASYMPOSIUM ON CATARACT, IOL AND REFRACTIVE SURGERY
San Francisco, California April 3–8, 2009
Graft marking method surgical steps(V. Kopayeva, 1982) 3
Graft placed onto the wound bed
of the recipient cornea. The marks on the corneas of the donor and the recipient are precisely adjusted
Fixation of the graft by four interrupted sutures strictly along by the adjusted marks
Fasterning of the graft by continuous suture. Interrupted sutures removed
ASCRS/ ASOASYMPOSIUM ON CATARACT, IOL AND REFRACTIVE
SURGERY San Francisco, California
April 3–8, 2009
ASCRS/ ASOASYMPOSIUM ON CATARACT, IOL AND REFRACTIVE
SURGERY San Francisco, California
April 3–8, 2009
Results
Mean recipient age was 42 years (24 – 72) Almost all patients had visual acuity sufficient for
reading 180 patients reached UCVA 10/20. Postoperative
astigmatism noted in 32 % cases within 0.5 – 2.5 D, in 68% -within 4.0 D
ASCRS/ ASOASYMPOSIUM ON CATARACT, IOL AND
REFRACTIVE SURGERY San Francisco, California
April 3–8, 2009
ASCRS/ ASOASYMPOSIUM ON CATARACT, IOL AND
REFRACTIVE SURGERY San Francisco, California
April 3–8, 2009
Results
11 cases of secondary graft failure (4%) registered
Survival of the first time grafts was 98.9 % at 5 years, 98.0% at 10 years, 98.0 % at 20 years and 96.0 % at 30 years after PKP
Regrafting was done due to secondary graft failure, trauma, herpetic keratitis recurrence
Secondary graft failure12 months after primary
low –risk PKP
Secondary graft failure12 months after primary
low –risk PKP
ASCRS/ ASOASYMPOSIUM ON CATARACT, IOL AND
REFRACTIVE SURGERY San Francisco, California
April 3–8, 2009
ASCRS/ ASOASYMPOSIUM ON CATARACT, IOL AND
REFRACTIVE SURGERY San Francisco, California
April 3–8, 2009
Conclusions
There is limited number of publications on graft survival
with a follow – up longer than 10 years The long-term survival rates demonstrate that PKP is safe
and effective treatment in corneal diseases transplanted in Russia and prove possibility to maintain clear graft over long term with minimal postoperative astigmatism
Despite low risks of graft failure in uncomplicated eyes rejection possibility substantiates follow – up over whole life span
ASCRS/ ASOASYMPOSIUM ON CATARACT, IOL
AND REFRACTIVE SURGERY San Francisco, California
April 3–8, 2009