Combined Intrastromal Implantation of a Semipermeable Hydrogel Membrane in Case of Corneal Graft Failure and Multiple Keratoplasty (Clinical Observation)

Abstract

Introduction: penetrating keratoplasty (PK) is an effective method for the surgical treatment of corneal failure and its layers and low visual acuity. It is well-known that the graft degrades over time, it is associated with “chronic immune destruction”. Rekeratoplasty is conducted in case of rapid decrease of transplant functions, but even with multiple rekeratoplasty iterations, the result can be unstable.Patient and methods. Patient D., 42 years old, complaints to low vision of left eye — arm movement 10 cm on face. Both eyes have been previously surgically operated for the last 10 years. Two iterations of an artificial iris transplantation in combination with IOL implantation, and Ahmed drainage implantation and five rekeratoplasty on the left eye were conducted. Corneal graft failure with transplant thickness — 802 μm. The patient suffers from Mediterranean fever and polyarthritis. We conducted a course of conservative therapy, which increased visual acuity to 0.05. Then we performed a surgical procedure for hybrid type of keratotransplantation. The following procedures were gradually conducted: mechanical removal of epithelium, femto-laser formation in a recipient’s replaceable corneal disk formation with 500 μm thick and a diameter of 7.0 mm, removal of disk, femto-laser formation of a central penetrating hole with a diameter of 3 mm opposite the artificial pupil, placing of the hydrogel graft 60 μm thick on the bottom of the bed. Hydrogel graft was covered by a donor corneal graft, which was fixed by interrupted sutures and soft contact lens.Results: Visual acuity of the left eye after 1 day after keratoplasty — 0.2; after 1 month — 0.3, the transplant was transparent; after 4 months — 0.4 with complex correction — 0.7, the transplant was transparent, the thickness of the donor disc — 275 μm.Conclusion. After multiple rekeratoplasty iterations the presented method of combined keratotransplantation allows to obtain a non-permanent effective result. At the same time, the polymer metabolism is preserved, since it has a circulation with the front camera. The case requires further observation.

Keywords

• penetrating keratoplasty
• deep anterior lamellar keratoplasty
• hydrogel implant
• corneal graft failure