Resultados visuales y sobrevida de injerto obtenidos en una población pediátrica sometida a queratoplastia / Visual outcomes and graft survival in pediatric patients underwent penetrating keratoplasty

Objetivo: Describir resultados visuales y complicaciones de una serie de casos de pacientes pediátricos a los que se les realizó queratoplastia penetrante en el Hospital de San José, en Bogotá, Colombia. Diseño: Estudio observacional descriptivo, retrospectivo, serie de casos. Método: Se evaluaron 14 ojos de 12 pacientes menores de 16 años a quienes se les realizó queratoplastia penetrante entre los años 1999-2014. Se hizo una revisión de la literatura sobre etiología, manejo quirúrgico, seguimiento y sobrevida de injerto. Resultados: De los 14 ojos estudiados 8 ojos (57,1%) tenían patología congénita con injerto claro en 6 ojos (75%) entre los 3 y 9 meses, 3 ojos (21,4%) tenían etiología traumática, de estos, todos los injertos permanecieron claros en un rango de 3 meses a 11 años y 3 ojos (21,4%) tenían leucomas, queratitis o inminencia de perforación, de estos el injerto permaneció claro entre los 3 y 18 meses. Se encontró una mejoría de visión en 8 de los ojos evaluados (57,1%). Las complicaciones encontradas en estos pacientes fueron: glaucoma en 5 ojos (35.7%), falla de injerto en 6 ojos (42.8%), rechazo endotelial en 7 ojos (50%) y desprendimiento de retina en 1 ojo (7.14%). Conclusión: En el estudio, la mejoría visual fue ligeramente menor a la reportada en la literatura. Las complicaciones presentadas fueron principalmente rechazo endotelial y falla de injerto, lo que difiere de la literatura donde la catarata es la principal complicación.

Purpose: To describe visual results and complications in a case series of paediatric patients who underwent penetrating keratoplasty at Hospital de San José in Bogotá, Colombia. Design: Observational, descriptive and retrospective study, series of cases. Method: 14 eyes of 12 patients under 16 years (2 months - 16 years) who underwent penetrating keratoplasty in Hospital de San Jose from 1999 to 2014 were evaluated. A literature review of etiology, surgical management, monitoring and graft survival of pediatric patients was done. Results: Of the 14 eyes studied, 8 eyes (57.1%) had congenital pathology with clear graft in six eyes between 3 and 9 months, 3 eyes (21.4%) had traumatic aetiology, of these, all graft s remained clear in a range of 3 months to 11 years and 3 eyes (21.4%) had leucoma, keratitis or impending perforation, of these, the graft remained clear between 3 and 18 months. An improvement in vision was found in eight of the evaluated eyes (57.1%). The complications found in these patients were: glaucoma in 5 eyes (35.7%), graft failure in 6 eyes (42.8%), endothelial rejection in 7 eyes (50%) and retinal detachment in 1 eye (7.14%). Conclusion: In our study, the visual improvement was slightly lower than that reported in the literature. The complications presented were mainly endothelial rejection and graft failure, which differs from the literature where cataract is the main complication.

One hundred-year-old human corneal and transplanted corneal graft endothelium.

PURPOSE: To investigate and analyse one hundred-year-old endothelial cells of human transplanted corneal grafts and compare them with intact endothelium of unoperated eyes. SUBJECTS AND METHODS: Specular microscopy was performed on seven individuals (14 eyes) aged >100 years and on seven transplanted corneas with endothelial cells of at least 100 years old. All keratoplasties were performed by the same surgeon (PR) 25-35 years before the time of examination. As controls, 14 unoperated healthy individuals (26 eyes) of 90-100 years, 12 individuals (24 eyes) of 48-52 years, 12 students (24 eyes) of 19-24 years and 11 children (22 eyes) from 10 to 14 years of age were photographed and analysed. RESULTS: The mean cell density in the oldest age group, over 100 years of age (average 102 years), was very good 2365 cells/mm(2) . The mean cell density in the transplanted corneas, the endothelial cells of which were over 100 years old (mean 106 years), was 923 cells/mm(2) (range 585-1800 cells/mm(2) ). CONCLUSION: Corneal endothelial cells may remain viable and capable to perform their function over 100 years. Donor corneas up to 70-75 years of age can be approved for transplantation, provided that the endothelial cells have been thoroughly evaluated with vital staining before the operation.

The relationship of graft survival and herpes simplex virus latency in recipient corneal buttons.

PURPOSE: To demonstrate relationship between herpes simplex virus (HSV) corneal latency and graft survival. METHODS: Prospective case control study. 28 recipient corneal buttons and donor cornea-scleral remnants were examined for HSV DNA with polymerase chain reaction (PCR). None of the recipient had a history of HSV infection. Serum samples of graft recipients were analyzed for the presence of anti-HSV IgG and IgM with enzyme-linked immunosorbent assay technique. All corneas were free of stromal scarring or epithelial defect before sampling and had an endothelial cell density of >2000 cells/mm(2). RESULTS: In twenty three patients (82%) anti-HSV IgG was detected in serum. In none of the recipients anti-HSV IgM was positive. HSV DNA was positive in six out of twenty eight (21%) of the recipient corneal buttons and none of the donor cornea-scleral remnants. In eighteen-months follow-up period three out of six (50%) HSV DNA positive and one out of twenty-two (4.5%) HSV DNA negative patients experienced late endothelial failure that was statistically significantly different (p = 0.022). CONCLUSION: Even without a history of HSV keratitis, presence of latent HSV virus in recipient cornea is an important risk factor for subsequent graft survival.