[Advantages and limits of multiple grafts (third keratoplasty) under local cyclosporin 2%]. / Intérêt et limite de la greffe multiple (troisième kératoplastie) sous ciclosporine locale 2 %

INTRODUCTION: iterative penetrating keratoplasty procedures (PKPs) increase the risk of graft rejection. Surgeons are reluctant to perform a third procedure following two previous graft failures. We evaluated the outcomes of patients who had three successive PKPs treated with a local combination of cyclosporin 2% A and dexamethasone 0.1% eye drops. PATIENTS AND METHODS: this is a retrospective study of a series of cases including 15 eyes of 15 patients treated and followed in the ophthalmology unit at the Hôtel-Dieu Hospital in Paris (2006-2009). RESULTS: after an average follow-up of 20.5±2 months, the risk of transplant rejection was 13.33% and the duration of follow-up corresponded in all patients to the duration of treatment with cyclosporin eye drops. The treatment was not interrupted by any patient because of intolerance. CONCLUSION: in this study, we observed a success rate justifying the indication of the third keratoplasty under local cyclosporin 2% classically considered debatable.

[Corneal tattooing. A series of 14 case studies]. / De l'usage du tatouage cornéen. A propos de 14 cas.

AIMS: Evaluate the efficacy of a little-used surgical method: corneal tattooing, using a dermograph to hide unsightly corneal scars on nonfunctional eyes. PATIENTS AND METHODS: Retrospective study of 14 eyes of 13 patients treated by tattooing the corneal surface, by directly introducing the pigments into the corneal stroma using a dermograph. The effectiveness of tattooing was evaluated by pigmentation homogeneity and patient satisfaction. Tolerance was evaluated by the scarring at the 7th day and ocular inflammation. The average follow-up was 18 months. RESULTS: Fourteen eyes presented an unaesthetic, neovascularized major corneal edema (79% traumatism). In 12 eyes, the treatment was homogeneous with a very satisfactory aesthetic result for the patient. One eye presented minor complications of pigmentary migration. One eye presented a corneal perforation 40 days after the procedure on a very pathological cornea. CONCLUSION: Corneal tattooing using a dermograph is a little-used technique since changes in corneal transplantation indications but is also a simple and inexpensive alternative for corneal scar treatment on nonfunctional eyes.