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