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Value Additions to High-Risk Keratoplasty

Radhika Natarajan, MD; R. Sree Sweta, MD; and Shruti Muralidharan, MD

Keratoplasty has better outcome and lower requirement for immunosuppression compared to other solid organ transplants given the inherent immune privilege and avascularity of the cornea. But, in vascularised corneas and regrafts, this privilege breaks down and makes the cornea susceptible to rejection. A cornea with two or more vascularized quadrants, or one in which a graft had previously been rejected is a high risk graft according to the Collaborative Corneal Transplantation Study.

Limbal stem cell deficiency (LSCD) contributes to graft failure by delaying epithelial healing. A milder form of LSCD called limbal stress is the focus of this video. This is more frequently encountered in situations like toxic medicamentosa, long-term contact lens usage, chronic corneal infections, and a history of multiple ocular surface surgeries.

A better outcome can be achieved in a high-risk group by understanding the underlying pathology with subsequent surgical modification. Adjuvant measures include meticulous tissue handling, immunosuppression, intraocular pressure and inflammation control. This video focusses on two procedures—fine needle diathermy (FND) for corneal vascularization and allogenic simple limbal epithelial transplantation for LSCD.

Posted: 11/11/2024