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Khalil ERRAIS, Omar BELTAIEF, Amel OUERTANI. Charles Nicolle University Hospital, Tunis, Tunisia.

Delayed Corneal Reepithelialization and Corneal Epithelial Defect after Penetrating Keratoplasty : Incidence, Risk Factors and Consequences. Khalil ERRAIS, Omar BELTAIEF, Amel OUERTANI. Charles Nicolle University Hospital, Tunis, Tunisia.

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Khalil ERRAIS, Omar BELTAIEF, Amel OUERTANI. Charles Nicolle University Hospital, Tunis, Tunisia.

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  1. Delayed Corneal Reepithelialization and Corneal Epithelial Defect after Penetrating Keratoplasty: Incidence, Risk Factors and Consequences. Khalil ERRAIS, Omar BELTAIEF, Amel OUERTANI. Charles Nicolle University Hospital, Tunis, Tunisia. The authors have no financial interest in the subject matter of this poster.

  2. INTRODUCTION • Delayed Corneal Reepithelialization (DCR) and Corneal Epithelial Defect (CED) after Penetrating Keratoplasty are serious and urgent clinical problems which can threaten patient vision. • Purpose : to report : • Incidence • Risk factors • Consequences of DCR and CED after penetrating keratoplasty.

  3. METHODS • Retrospective study • 357 cases of penetrating keratoplasty performed between 1994 and 2008 at Charles Nicolle University Hospital, Tunis,Tunisia. • Reepithelialization process and epithelial status was evaluated by slit lamp biomicroscopy and fluorescein staining. • Definitions: • Delayed corneal reepithelialization (DCR): complete corneal reepithelialization not achieved within 8 days. • Corneal epithelial defect (CED): occurrence of an epithelial defect after complete reepithelialization. • Recipient pre and postoperative variables and donors characteristics were recorded and crossed with DCR and CED.

  4. RESULTS • Sixty one cases (19.9%) presented DCR and CED. • Statistically significant risk factors of post keratoplasty DCR and CED: * dry ocular syndrome (p=0.004) * pre-operative glaucoma (0.002) * blepharo-conjonctivitis (p=0.05) * conjunctival allergy (p=0.04) * primary graft oedema (p=0.001) * post-operative inflammation • (p=0.001) * post-operative ocular hypertony • (p=0.003). eded Delayed corneal reepithelialization evaluated by fluorescein staining

  5. RESULTS • Factors without statistically significant association : • Anatomic lid disorder (entropion and trichiasis) (p=0,13) • Graft preservation-to surgery time (p=0,2) • Receiver age over 55 years (p=0,4) • Donor age over 55 years (p=0,15) • Graft infection (p= 0,2) • Post keratoplasty DCR and CED had a statistically significant association with corneal rejection (p=0,00003) and graft failure (p=0.00004).

  6. DISCUSSION • Incidenceof DCR and CED is reported between 8% and 29% in literature(1,2), • Risk factorsof DCR and CEDstudied in our serie compared with litterature:

  7. DISCUSSION • Consequences: DCR and CED may induce graft infection, scarring, neovascularization, thinning, and perforation. All these complications can lead to graft rejection and failure.That’s why DCR and CED are related to corneal rejection and graft failure. (1,6) Graft failure

  8. CONCLUSION • Delayed corneal reepithelialization and corneal epithelial defect are common complications of penetrating keratoplasty. • Several risk factors essentially ocular surface diseases and inflammation may lead to these complications. • Identification and active treatment of these factors are essential to prevent this serious problem, which not only can delay visual rehabilitation but also increase risk of graft failure.

  9. BIBLIOGRAPHIE • Rumelt S, Bersudsky V, Blum-Hareuveni T, Rehany U. Persistent epithelial defects and ulcers in repeated corneal transplantation: incidence, causative agents, predisposing factors and treatment outcomes. Graefes Arch Clin Exp Ophthalmol. 2008 Aug;246(8):1139-45. Epub 2008 May 2 • Machado RA, Mannis MJ, Mandel HA, Feiz V, Schwab IR, Wang W, Wang JL. The relationship between first postoperative day epithelial status and eventual health of the ocular surface in penetrating keratoplasty. Cornea. 2002 Aug;21(6):574- • Feiz V, Mannis MJ, Kandavel G. Surface keratopathy after penetrating keratoplasty. Trans Am Ophthalmol Soc 2001;99:159-68. • Mannis MJ, Zadnik K, Miller MR. Preoperative risk factors for surface disease after penetrating keratoplasty. Cornea 1997;16:7-11. • Kim T, Palay DA, Lynn M. Donor factors associated with epithelial defects after penetrating keratoplasty. Cornea 1996;15:415-56. • Vajpayee RB, Boral SK, Dada T, Murthy GVS. Risk factors for graft infection in India: a case-control study. Br J Ophthalmol 2002;86:261-265.

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