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. 2021 Oct;69(10):2812-2817.
doi: 10.4103/ijo.IJO_1183_21.

Intermediate outcomes of therapeutic penetrating keratoplasty for severe microbial keratitis using glycerol-preserved donor corneas during the COVID-19 pandemic

Aravind Roy  1 , Dhruv Kamra  2 , Somasheila I Murthy  2 , Ashik Mohamed  3 , Sunita Chaurasia  2 , Merle Fernandes  4 , Sujata Das  5 , Savitri Sharma  6
Affiliations

Intermediate outcomes of therapeutic penetrating keratoplasty for severe microbial keratitis using glycerol-preserved donor corneas during the COVID-19 pandemic

Aravind Roy et al. Indian J Ophthalmol. 2021 Oct.

Abstract

Purpose: To report the intermediate outcomes of therapeutic penetrating keratoplasty (TPK) performed for severe microbial keratitis using glycerol-preserved corneas during the Corona virus diseases of 2019 (COVID-19).

Methods: Retrospective non-comparative case series from April to August 2020 in a network of tertiary eye care centers. Glycerol-preserved tissues were used for therapeutic keratoplasty (TPK). We reviewed the demographics, microbiology, surgical outcomes such as wound integrity, recurrence, graft melt, epithelialization, and complications.

Results: A total of 49 eyes that underwent TPK with glycerol-preserved corneal tissues were analyzed. The primary indication was severe microbial keratitis in 47 eyes. The majority was a fungal infection in 33 eyes (67.3%). The mean age was 53.8 ± 12.2 years, with male predominance (3:1). The corneas were stored for an average of 85.5 ± 53 days prior to transplant. The median donor age was 65 years. The grafts were tectonically stable in 32/36 eyes (88.9%) at 1 month and 20/24 eyes (83.3%) at 3 months. The graft melt was noted in three eyes at 1 and 3 months. The recurrence of the infection was noted in four eyes and all were of fungal etiology. The graft epithelialization was delayed with a mean duration of 48.9 ± 25 days after surgery. Post-TPK, raised intra-ocular pressure (>21 mm Hg) was noted in 51.2% at 1 week, 17.4% at 1 month, and 11.8% at 3 months.

Conclusion: Glycerol preservation is a reliable alternative with good therapeutic outcomes in the short and interim postoperative period. Delayed epithelialization and secondary glaucoma were the commonest postoperative complications.

Keywords: Corneal transplant outcomes; glycerol-preserved corneas; severe microbial keratitis; therapeutic keratoplasty.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Representative clinical pictures of a patient of fungal keratitis at presentation (a and b) edematous graft 11 days post-TPK, (c) the smear showed fungal filaments in 10% potassium hydroxide + Calcofluor white wet mount X40 magnification, Greenish-yellow velvety fungal colony on potato dextrose agar (d).
Figure 2
Figure 2
Representative clinical picture of a patient of Acanthamoeba keratitis at presentation (a) and 20 days postoperatively (b). The smear showed Acanthamoeba cyst in 10% potassium hydroxide + Calcofluor white wet mount X40 magnification (c).
Figure 3
Figure 3
Kaplan–Meir survival estimate of therapeutic success in 49 patients
See this image and copyright information in PMC

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