98th Annual Meeting DOG 2000

P 30

Quantification of blood-aqueous barrier breakdown after penetrating keratoplasty with simultaneous extracapsular cataract extraction and posterior chamber lens implantation

N. X. Nguyen, A. Langenbucher, B. Seitz, M. Graupner, C. Cursiefen, M. Küchle

Background: The purpose of this study was to quantify breakdown of the blood-aqueous barrier (BAB) following penetrating keratoplasty (PK) with simultaneous extracapsular cataract extraction and posterior chamber lens implantation (triple procedure) and compare to the alterations following PK only.

Patients and Methods: This study included 68 eyes after triple procedure and 171 eyes after PK only. The diagnosis for PK was Fuchs´dystrophy 39%, keratokonus 44%, stromal corneal dystrophy 3% and avascular corneal scars 6%. The postoperative topical steroid treatment was standardized in both groups. Aqueous flare was quantified using the laser flare-cell meter (FC-1000, Kowa) in a defined postoperative intervals (day 10, 6 weeks, then every 3 months until one year postoperatively) Patients with conditions that may lead to impairment of the BAB were excluded from the study.

Results: In the early postoperative course aqueous flare values (photon counts/ms) were significantly higher in patients with triple procedure (21.9 ± 11.0) than in patients with PK only (8.8± 3.2; p = 0.01). At 6 weeks postoperatively, aqueous flare returned to normal levels in patients after PK only (5.2± 2.3), whereas patients with triple procedure still showed significantly increased flare values (8.8± 4.6; p=0.01). At 6 months postoperatively, aqueous flare values of patients with triple returned to normal levels (7.0± 3.8) and did not differ significanlty from those after PK only.

Time

day 10

6 weeks

3 months

6 months

9 months

12 months

Triple-OP

21.0 ± 11.0

8.8± 4.6

9.2 ± 4.8

7.0 ± 3.8

6.3 ± 2.5

6.7 ± 3.6

PK only

8.8 ± 3.2

6.2± 2.3

5.1 ± 2.1

4.7 ± 1.9

5.1 ± 2.3

5.0 ± 1.8

Conclusion: Our results indicate that triple-procedure causes a more serious and longer lasting breakdown of the blood-aqueous barrier than PK only. Further studies are required to investigate the clinical relevance of BAB-breakdown on endothelial cell count and the incidence of immunological graft rejection.

Department of Ophthalmology, University of Erlangen-Nürnberg, Schwabachanlage 6, D-91054 Erlangen, Germany
Supported by BMFT (IZKF, Project B13)



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