[Keratoplasty à chaud]

Abstract

Between 1980 and 1992 we performed 128 keratoplasties à chaud on 69 (54%) eyes with progressive bacterial and on 59 (46%) eyes with progressive herpetic keratitis. In 44 of the eyes the corneas were spontaneously perforated, and in 28 (22%) a descemetocele was present. Only grafts that had been followed for at least 1 year (3.2 +/- 2.4 years) were analyzed. During this time 88 (95%) of the severely threatened eyes were preserved. In the operated eyes visual acuity improved in 20 (54%) in the bacterial and in 36 (69%) in the herpetic group. The main complications were immunological allograft rejection, cataract progression and recurrence of herpes. Allograft rejection occurred in 29 (71%) of the bacterial grafts and remained irreversible in 18 (44%) cases. 30 (63%) eyes in the group with herpetic corneal lesions developed graft rejection, 19 (37%) of these rejections were irreversible. Cataract occurred in the postoperative course in 25 (61%) of the bacterial eyes and in 23 (44%) of the herpetic ones. Recurrence of herpes presented a specific problem in this group and appeared in 12 (23%) of the grafts during a follow-up of 1 month to 12 years (3.8 +/- 2.4 years). Our results demonstrate that keratoplasty à chaud is a valuable form of managing urgent pathological processes of the cornea and shortening the course of the disease. This procedure also allows satisfactory primary functional results in many cases, however, secondary re-keratoplasty and cataract surgery are necessary to achieve functional rehabilitation.