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Long-term Outcomes of Penetrating Keratoplasty in Chronic and Delayed Mustard Gas Keratitis

Javadi, Mohammad Ali MD; Yazdani, Shahin MD; Kanavi, Mozhgan Rezaei MD; Mohammadpour, Mehrdad MD; Baradaran-Rafiee, Alireza MD; Jafarinasab, Mohammad Reza MD; Einollahi, Bahram MD; Karimian, Farid MD; Zare, Mohammad MD; Naderi, Mostafa MD; Rabei, Hossein Mohammad MD

doi: 10.1097/ICO.0b013e3181334752
Clinical Science

Purpose: To report the long-term outcomes of penetrating keratoplasty (PKP) in war victims with chronic and delayed mustard gas keratitis.

Methods: This noncomparative interventional case series includes patients with advanced chronic or delayed mustard gas keratitis who had undergone PKP from 1989 to 2006. Best-corrected visual acuity (BCVA), graft clarity, episodes of graft rejection, duration of steroid use, and complications were evaluated. Histopathologic features of excised corneal buttons were also evaluated.

Results: Overall, 22 eyes of 19 patients underwent PKP. Mean age at the time of surgery was 41 ± 4.6 years (range, 36-54 years), and mean follow-up duration was 40.9 ± 48 months (range, 4-204 months). The graft remained clear in 17 (77.3%) eyes and failed in 5 (22.7%) eyes. Overall, 13 (59.1%) eyes experienced episodes of endothelial rejection, and 5 (22.7%) eyes had subepithelial immune rejection, 4 of which had simultaneous endothelial rejection. Fifteen (68.2%) eyes received topical steroids for >6 months. Fourteen (63.6%) eyes developed cataracts, leading to cataract extraction in 7 eyes. One eye developed steroid-induced glaucoma after multiple episodes of endothelial graft rejections. Mean preoperative BCVA was 1.92 ± 0.63 logMAR, which improved to 1.04 ± 0.65 logMAR (20/200) overall and 0.8 ± 0.3 logMAR (20/120) in eyes with clear grafts (P < 0.001). Main histopathologic features of excised corneal buttons included corneal thinning and ulceration, loss of keratocytes, acute and chronic inflammation, stromal vascularization, and degenerative sequelae of long-standing inflammation.

Conclusions: PKP in chronic or delayed-onset mustard gas keratitis should be considered as a high-risk graft; however, with appropriate management, graft clarity and visual outcomes may be favorable.

Author Information

From the *Department of Ophthalmology, Labbafinejad Medical Center and Ophthalmic Research Center, Shaheed Beheshti Medical University, Tehran, Iran; the †Department of Ophthalmology, Baqiatallah Medical Center, Baqiatallah Medical University, Tehran, Iran; and the ‡Department of Ophthalmology, Imam Hossein Medical Center, Shaheed Beheshti Medical University, Tehran, Iran.

Received for publication February 8, 2007; revision received May 24, 2007; accepted June 3, 2007.

The authors state that they have no proprietary interest in the products named in this article.

Reprints: Mohammad Ali Javadi, Labbafinejad Medical Center Boostan 9 St, Pasdaran Avenue, Tehran 16666, Iran (e-mail:

Copyright © 2007 Wolters Kluwer Health, Inc. All rights reserved.