| Objective: To clinically observe and evaluate optical penetrating keratoplasty in the eyes with severe keratomycosis after therapeutic penetrating keratoplasty.Methods: Centric trephination of recipient corneal beds of 7. 25~ 7. 5 mm in diameter. The anterior or posterior synechia iris was lysed, and fibrinoid membrane either on the iris or the crystal lens surface was peeled off. The opaque crystal lens was also simultaneously removed with an IOL implantation. Before cataract surgery, if the pupil was small and fixed, sphintectomies was performed for smoothly cataract extraction, and suturing at the conclusion. If iris defect was identified during surgery, it was also sutured to reconstruct an artificial pupil. After that, an endothelial healthy corneal button with 0. 25mm or 0. 5 mm oversize was grafted by 10-0 running or interrupted suture.Results: There were 19 eyes in 19 cases in whom the severe fungal keratitis had been treated by therapeutic PKP at least 6 months before when fungal infection had been eradicated andocular inflammation had resolved. Among them, 8 eyes received re-grafts of optical PKP only, and 11 received combined optical PKP with ECCE and IOL implantation. During the follow-up period of 6 to 50 months after optical PKP, 4 eyes experienced graft failure due to immunologic rejection and 15 retained clear grafts. Postoperative visual acuity at last visit was 0.4 or better inl2 eyes, and 0.1 or better in 15 eyes, and less than 0. 1 in 4 eyes. Conclusions: Optical PKP performed in the eyes with severekeratomycosis after therapeutic PKP was a safe and easy surgery, and a high rate of postoperative clear corneal graft may be long-term achieved by this setting of surgeries.
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