PENETRATING KERATOPLASTY IN CICATRIZING CONJUNCTIVAL DISEASES

Purpose: The outcome of successful penetrating keratoplasty (PK) typic ally is poor in eyes with end-stage chronic cicatrizing conjunctival d iseases such as ocular cicatricial pemphigoid (OCP), Stevens-Johnson s yndrome, and toxic epidermal necrolysis due to immunologically driven conjunctival inflammation associated with conjunctival cicatrization a nd lid abnormalities, severe dry eye, and extensive corneal neovascula rization. The authors report the results of their experience with PK i n 13 patients with OCP, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Methods: The authors reviewed the records of patients with OCP, Stevens-Johnson syndrome, or toxic epidermal necrolysis seen bet ween 1976 and 1992. Patients who underwent PK were examined for the pu rpose of this study. Initial and final visual acuity, indications for PK, surgical procedure, postoperative therapy, complications, total nu mber of repeat PKs, length of follow-up, and the final outcome were re corded. Results: Thirty-two PKs were performed in 16 eyes of 13 patien ts with advanced OCP (6 patients), OCP as a sequels of Stevens-Johnson syndrome (2 patients), Stevens-Johnson syndrome (3 patients), and tox ic epidermal necrolysis (2 patients). The indications for the first PK were corneal perforation in six eyes (37.5%) and extensive corneal sc arring in ten eyes (62.5%). Preoperative visual acuity was counting fi ngers in five eyes, hand motions in eight, and light perception in thr ee. Preoperative therapy included systemic chemotherapy (8 patients), mucous membrane grafting (9 eyes), lamellar keratoplasty (2 eyes), sup erficial keratectomy (1 eye), and corneal dye laser photocoagulation ( 6 eyes). The mean follow-up period was 4.6 years (3 months-13 years). Eight eyes (50%) had clear grafts, and three eyes (18.7%) had 20/200 o r better visual acuity at last visit. The major causes of graft failur e were epithelial defect formation/persistence, stromal ulceration, pe rforation, and graft rejection. Conclusions: These results indicate th at PK may be performed for tectonic reasons, but prospects for restora tion of sight in patients with advanced cicatrizing conjunctival disea ses, even after extensive preoperative medical and surgical therapy, a re limited.