**Part 3**

**Complications of Keratoplasties** 

98 Keratoplasties – Surgical Techniques and Complications

contact with the trabecular meshwork. Therefore, we think angle compression by the haptics is not a major cause for IOP elevation in our cases. However, we do believe that glaucoma is an issue that deserves special attention when DSAEK is planned to be undertaken in aniridic cases with BDI lens. A well control of IOP preoperatively and close postoperative follow-up

It is also essential to find out the main reasons for endothelial decompensation in these three cases. Trauma can cause endothelial loss. Congenital aniridia could also associate with endothelial deficiency, although the most common corneal change is limbal stem cell deficiency.7,8 Normally, the BDI lens was sutured to the ciliary sulcus, it should has no friction with the endothelium unless the BDI lens is decentered or displaced anteriorly.5,6 In our three patients, UBM showed that the BDI lens were in the right position, and the endothelial cell counts before BDI lens implantation were already lower than the normal value. We think that BDI lens did not contribute to endothelial cell loss in our three cases,

[1] Bradley JC, McCartney DL. Descemet's stripping automated endothelial keratoplasty in

[2] Price MO, Price FW Jr, Trespalacios R. Endothelial keratoplasty technique for aniridic

[3] Suh LH, Kymionis G, Culbertson WW, et al. Descemet's stripping with endothelial

[4] Grant WM, Walton DS. Progressive changes in the angle in congenital aniridia, with development of glaucoma. Trans Am Ophthalmol Soc. 1974;72:207-28. [5] Reinhard T, Engelhardt S, Sundmacher R. Black diaphragm aniridia intraocular lens for congenital aniridia: Long-term follow-up. J Cataract Refract Surg. 2000;26:375-81. [6] Implantation of the Black Diaphragm Intraocular Lens in Congenital and Traumatic

[7] Mackman G, Brightbill FS, Optiz JM. Corneal changes in aniridia. Am J Ophthalmol

[8] Ramaesh K, Ramaesh T, Dutton GN, Dhillon B. Evolving concepts on the pathogenic

mechanisms of aniridia related keratopathy. Int J Biochem Cell Biol. 2005;37:547-57.

keratoplasty in aphakic eyes. Arch Ophthalmol 2008;126:268 –70.

intraoperative floppy-iris syndrome: Suture-drag technique. J Cataract Refract

and thus it was not necessary to remove the lens during DSAEK.

aphakic eyes. J Cataract Refract Surg. 2007;33:376-9.

Aniridia. Ophthalmology 2008;115:1705–1712

to monitor the IOP is recommended.

Surg. 2007;33:1149-50.

1979;87:497–502.

**4. References** 

**7** 

*Colombia*

Patricia Durán Ospina

**The Complications After Keratoplasty** 

Keratoplasty is the medical term that refers to a cornea transplant. There are some differences between the definitions of keratoplasty, commonly it is mentioned for corneal transplant, Lamellar Keratoplasty, which is a partial thickness corneal grafting and penetrating keratoplasty: is a full-thickness corneal grafting. The indications for keratoplasty include: optical (to improve visual acuity by replacing the opaque host tissue by a healthy donor or pesudophakic bullous keratopathy), tectonic (in patients with stromal thinning and descemetoceles, to preserves corneal anatomy ant integrity), therapeutic (removal of inflamed corneal tissue refractive to treatment by antibiotics or antiviral drugs) or cosmetic

The most frequent causes of corneal alterations leading to keratoplasty are keratoconus, bacterial infections, poor hygienic contact lens wear (Buehler et al. 1992, Chalupa, 1987, Holden, 2003) or trauma. Among microbial infections, bacterial infections are the most frequent and are mainly caused by *Staphylococcus sp., Streptococcus sp. or Pseudomona sp.* Some side effects of keratoplasty can be infection (keratitis on the new transplanted cornea or endophthalmitis), transplant rejection, vision fluctuation, glaucoma and bleeding, among others less reported. Infection is one of the most frequent complications after keratoplasty, which can cause endophthalmitis. Infection after keratoplasty, can result from inapropiate healing or like a complication during the transplant (Confino and Brown, 1985 and Dana, 1995). even though the area around the eye is completely sterilized the day of the surgery and the face is covered with sterile drapes. Despite these actions to keep the surgical area

On the other hand, transplant rejection is one of the hardest complications after keratoplasty. It occurs when the body rejects the new cornea. But it can occur from days to several years after surgery. Symptoms that show that the immunological system has rejected the cornea may be redness of the eye, an extreme sensitivity to light and pain, autoimmune diseases, infiltrates and also unknown causes. Signs of rejection may occur anywhere from one month to several years after the transplant surgery. On these cases, keratoplasty can be repeated when the transplant is rejected and oral immunosupresor drugs must be taken for long time to reduce the rejection. Some authors are reported also vision fluctuation after keratoplasty, frequent symptoms are poor vision and fluctuations for up to several months or years. Not until the vision has reached a constant and the sutures have been removed can the individual be given a prescription for eyeglasses or

(in patients with corneal scars giving a whitish opaque hue to the cornea.

**1. Introduction** 

clean, infections still may occur.

special contact lenses.

*Fundación Universitaria del Área Andina Seccional Pereira* 
