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. 2024 Aug 18;17(8):1431-1436.
doi: 10.18240/ijo.2024.08.07. eCollection 2024.

A surgical alternative of fusiform penetrating keratoplasty for the management of severe infectious keratitis

Xiao-Lin Qi  1 , Li-Chao Wang  1 , Miao-Lin Wang  1 , Hua Gao  1
Affiliations

A surgical alternative of fusiform penetrating keratoplasty for the management of severe infectious keratitis

Xiao-Lin Qi et al. Int J Ophthalmol. .

Abstract

Aim: To describe the surgical procedure of fusiform penetrating keratoplasty (FPK) using multiple trephines of different sizes for treating patients with severe infectious keratitis.

Methods: Fourteen eyes underwent FPK, and 15 eyes received conventional penetrating keratoplasty (PK) were included in the study. The best-corrected visual acuity (BCVA), refractive outcomes, endothelial cell density, and postoperative complications were recorded.

Results: The FPK group was followed for an average of 15.3±2.1mo, whereas the PK group was followed for 16.1±1.9mo. The corneal ulcers were elliptical-shaped in all 14 eyes in the FPK group. The mean BCVA (logMAR, 0.26±0.13) showed no statistically significant differences from that in the PK group (logMAR, 0.21±0.12, P>0.05) at 1y after surgery. But the mean curvature, mean astigmatism, and mean spherical equivalent in the FPK group were lower than those in the PK group (P<0.05). Peripheral anterior synechia was observed in one patient in the FPK group, whereas 6 patients in the PK group. Suture loosening and neovascularization were observed in 4 and 5 eyes in the PK group, respectively. No graft immune rejection or elevation of intraocular pressure was observed in the two groups.

Conclusion: For patients with elliptical-shaped corneas or corneal ulcers, FPK can avoid disrupting of corneal limbus, reduce the risk of postoperative complications, and can result in satisfactory visual quality.

Keywords: cornea; fusiform penetrating keratoplasty; infectious keratitis; multiple trephines.

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Conflict of interest statement

Conflicts of Interest: Qi XL, None; Wang LC, None; Wang ML, None; Gao H, None.

Figures

Figure 1
Figure 1. The diagram and surgical procedures of FPK
A, B: Picture A is the diagram of picture B. A suitable trephine (the yellow circle) is larger than the longest diameter of the ulcer. Two methylene blue marks (the solid lines of the two blue circle) were made with the ulcer included inside using the trephine, and the intersection of the two arcs was shown in a fusiform shape. C, D: The Castroviejo circle gauge was used to measure the longest and the shortest diameter of the fusiform recipient bed. E, F: The Castroviejo circle gauge was used to mark the longest and the shortest diameter of the graft, then a fusiform graft was cut along the indentation using corneal scissors. G: The diseased cornea was dissected along the indentation of the recipient bed. H: The donor cornea was sutured to the recipient bed with 16 interrupted 10/0 nylon sutures. FPK: Fusiform penetrating keratoplasty.
Figure 2
Figure 2. Slit-lamp and ultrasonic biomicroscopy examination of the FPK group and PK group
A: Preoperative slit-lamp photograph showed a patient with Acanthamoeba keratitis; B: A clear graft was observed at 1y after FPK; C: Ultrasonic biomicroscopy showed peripheral anterior angle is open; D: Preoperative slit-lamp photograph showed a patient with bacterial keratitis; E: Corneal neovascularization was observed at 1y after PK; F: Extensive peripheral anterior synechia was observed by ultrasonic biomicroscopy. PK: Penetrating keratoplasty; FPK: Fusiform penetrating keratoplasty.
Figure 3
Figure 3. Cumulative BCVA (logMAR) of the FPK group and PK group
A: Patients' cumulative BCVA preoperative, 1y after surgery and 3mo after suture removal in the FPK group; B: Patients' cumulative BCVA preoperative, 1y after surgery and 3mo after suture removal in the PK group. PK: Penetrating keratoplasty; FPK: Fusiform penetrating keratoplasty; BCVA: Best corrected visual acuity.
Figure 4
Figure 4. Attenuation of ECD in the FPK and PK group
ECD: Endothelial cell density; PK: Penetrating keratoplasty; FPK: Fusiform penetrating keratoplasty.
See this image and copyright information in PMC

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