| Objective:To investigate the clinical results of the optical penetrating keratoplasty (O-PKP)in the eyes after therapeutic penetrating keratoplasty(T-PKP) using cryopreserved donor corneas.Method:We retrospectively reviewed the clinical records of the patients for whom O-PKP has been carried out for at least 6 months after T-PKP using cryopreserved donor corneas from October 1998 to October 2008.The postoperative graft servive state, complications,the change of endothelial cell density and visual acuity outcome were analysised.Result:There were 44 eyes in 44 cases been oberved.During the median follow-up period of 19(6-76)months after O-PKP,14 eyes(31.8%)experienced graft failure,the graft servival rate was 68.2%, the mean survival time of the grafts was 49.8±5.0 months,we analysised the risk factors of graft failure,the relative risk of the episode of second glaucoma after O-PKP was 6.72(P=0.04<0.05),the relative risk of the episode of graft rejection was 20.10(P=0.01),both were statistically related with the eposide of graft failure,while the age,the perforation status before T-PKP, the diameter of the grafts of T-PKP, implantation of intraocular lens, the intraocular surgery after O-PKP are not statistically related.15 eyes (34.1%)suffered from secondary glaucoma which can't be controlled by drug or anti-glaucom after T-PKP, which significantlly decreased to 5 eyes after O-PKP(P<0.05).The medial intraocular pressure of the 15 eyes above-mentioned was 38.3±9.0mmHg, which significantlly decreased to 17.7±8.9mmHg,18.0±7.5mmHg,17.1±6.5mmHg of the 1st,the 6th and the 12th month after O-PKP while the detachement of the goniosynechia and reconstruction of anterior segment was done (P<0.01).23 eyes(52.3%) experienced graft rejection after O-PKP,all were controlled by drugs,but 13 eyes suffered from graft failure finally. Among the 17 eyes whose lens were preserved after optical PKP,12 eyes(70.6%) experienced complicated cataract,the mean survival time of crystalline lens was 24.1±3.7months.The total endothelial cell density of the 12th month were significantly decreased by 25.2±35.6% versus that of the 1st month after O-PKP(P<0.01). The median best corrected visual acurity(BCVA)of the 6th months after O-PKP was 0.35,which was improved to 0.4 on the 12th months,The median final BCVA was 0.15,19 eyes were better than 0.4.Conclusion:Satisfactory graft survival rate,low complication, good visual acurity outcome can be achieved by O-PKP after curing the primary disease and preserve the integrity of the eye ball by T-PKP using cryopreserved donor corneas.The risk factors of graft failure are the secondary glaucoma and the graft rejection after O-PKP.The morbidity of glaucoma after T-PKP can be reduced by O-PKP. |
