Emergency grafting

A new study shows strong evidence that emergency corneal grafting can be a successful sight-saving procedure

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Parwez Hossain MD
Results of a retrospective analysis of data from the UK Transplant Registry study provide strong evidence that emergency corneal grafting can be a successful sight-saving procedure. “There is a common perception among corneal surgeons that corneal grafting for severe corneal disease associated with infection and perforation carries unacceptable risks of rejection and failure. Consequently, many such patients are offered evisceration or enucleation. Our study, which we believe is the largest to investigate outcomes of emergency corneal grafts, should raise awareness that emergency corneal grafting is worthwhile,” said Parwez Hossain MD, speaking to EuroTimes. “We found that although there are risks that corneas may fail or reject, over a five-year period even in the worst high-risk case scenarios, the chance of graft survival is at least 40%. Most interestingly, if we look at the outcome over a shorter time period of just one year, the chance of graft survival rate is much higher. And, even if graft failure occurs, vision in many cases is still better than when the eye was in the acute stage pre-grafting. From a patient’s perspective, these odds make grafting a much better option than having the eye removed.” The favourable outcomes also speak to the importance of having eye banking facilities that are able to supply corneal tissue immediately for emergency grafting, said Dr Hossain, Associate Professor and Consultant Ophthalmologist, University of Southampton, UK, and lead author of the published article reporting on the study (Br J Ophthalmol. 2017 May 11, epub ahead of print). “This is important considering that in many parts of the world, eye banking facilities are rudimentary or non-existent for allowing corneal transplant material to be available in a few hours.”
[caption id="attachment_10089" align="alignleft" width="1024"] L-R: Patient with fungal keratitis with corneal perforation; Immediate post-penetrating keratoplasty of same patient[/caption] The study reviewed outcomes from 1,330 emergency corneal graft procedures performed between April 1999 and March 2005. The operations included 433 (33%) regrafts, were performed by 244 surgeons from 147 centres, and involved full thickness penetrating keratoplasty in 1,132 (85%) cases. About two-thirds of the procedures were in eyes with perforation, while threatened perforation and severe infection were each present in about 30% of eyes. Infection (39%) and non-infectious ulcerative keratitis (32%) were the most common diagnoses. Considering eyes undergoing a first emergency corneal graft, the graft survival rates at one, two and five years were 78%, 66% and 47%, respectively. As a reference, the investigators noted that the one-year survival rate for elective cornea graft operations is 90%. Median BCVA prior to grafting was hand movements. At one year, BCVA was improved in 81% of eyes and 6/12 or better in 30%. Previous studies providing information on outcomes of emergency corneal grafting have either focused on a subtype of emergency corneal grafts or included a low number of cases. Parwez Hossain: P.N.Hossain@soton.ac.uk
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