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Two-step keratoplasty for deep vascularized corneal opacity with severe peripheral thinning following Acanthamoeba keratitis

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Abstract

Purpose

In cases of corneal opacity with vascularization and peripheral thinning, traditional keratoplasty techniques have several risks and drawbacks. We report the results of a two-step surgical strategy consisting in performing a large diameter tectonic lamellar keratoplasty (TLK) to restore appropriate corneal thickness and an avascular recipient bed, followed by central optical PK within the lamellar graft at a later date.

Methods

This single-institution study analyzes the results of 7 eyes of 7 patients who received PK after large diameter TLK. All patients were affected by deep post-infectious corneal opacity with persistent stromal vascularization and peripheral thinning. The main outcomes measured were graft survival, visual acuity, refraction, and endothelial cell density.

Results

TLK was performed in all cases with 10/10.1-mm diameters. After a mean interval of 14 months, central PK was performed with a median host-graft diameter of 7.75/8.25 mm. Mean follow-up after PK was 52 months. At last follow-up, 6/7 (86%) grafts were clear. Endothelial rejection occurred in 5/7 (71%) eyes, with one patient having multiple episodes and subsequent graft failure. At 2 years, all patients had a visual acuity ≥ 20/40, with an average refractive astigmatism of 3.75 diopters.

Conclusion

Optical PK within a previous TLK is a safe and efficient technique for treating deep corneal opacity associated with extensive vascularization and peripheral thinning. Extended follow-up period is necessary to assess endothelial cell loss and long-term efficacy of the procedure.

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Data availability

The study and data accumulation were in conformity with all country, federal, and state laws.

Code availability

n/a.

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Authors and Affiliations

  1. Cornea and Ocular Surface Unit, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Karl Anders Knutsson, Giorgio Paganoni & Paolo Rama

Authors
  1. Karl Anders Knutsson
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  2. Giorgio Paganoni
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  3. Paolo Rama
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Contributions

All authors contributed to the study conception and design. Data collection and analysis were performed by Karl Anders Knutsson. The first draft of the manuscript was written by Karl Anders Knutsson and all authors contributed to the development of the final version. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Karl Anders Knutsson.

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Ethics approval and consent to participate

Ethical approval was waived by the local Ethics Committee (Ospedale San Raffaele Ethics Committee) in view of the retrospective nature of the study and all the procedures being performed were part of routine care. The study was in adherence to the tenets of the Declaration of Helsinki.

Informed consent was obtained for all patients.

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Not applicable, no identifying information.

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The authors declare no competing interests.

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Knutsson, K.A., Paganoni, G. & Rama, P. Two-step keratoplasty for deep vascularized corneal opacity with severe peripheral thinning following Acanthamoeba keratitis. Graefes Arch Clin Exp Ophthalmol 259, 2279–2285 (2021). https://doi.org/10.1007/s00417-021-05205-0

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