Postkeratoplasty Atopic Sclerokeratitis in Keratoconus Patients
Received 2 May 2007; received in revised form 28 June 2007; accepted 11 July 2007. published online 20 September 2007.
Purpose
To estimate the incidence of and investigate possible risk factors for postkeratoplasty atopic sclerokeratitis in keratoconus patients undergoing keratoplasty.
Design
Retrospective, noncomparative, interventional case series.
Participants
Two hundred forty-seven eyes with keratoconus.
Methods
We reviewed the medical records of all keratoplasty cases of keratoconus between May 2000 and December 2005 at Tokyo Dental College Ichikawa General Hospital. The incidence and clinical details of cases consistent with postkeratoplasty atopic sclerokeratitis were recorded.
Main Outcome Measures
Cases with acute sclerokeratitis during the early postoperative period were retrospectively evaluated.
Results
A total of 247 keratoconus eyes were followed at our clinic after keratoplasty (mean follow-up, 18.5±13.0 months). Thirty-five eyes of 29 patients (14.2%) had a history of atopic dermatitis, of which 6 eyes of 5 patients (2.4%) developed postkeratoplasty atopic sclerokeratitis. Mean age of postkeratoplasty atopic sclerokeratitis patients was 29 years (range, 23–39). The mean period between keratoplasty and onset of postkeratoplasty atopic sclerokeratitis was 26 days (range, 11–41). Loosening of running sutures and wound leakage were observed in 3 eyes; persistent epithelial defects in 3 eyes; and graft melting in 2 eyes, 1 of which was perforated. Preoperative atopic blepharitis and corneal neovascularization were identified as risk factors for postkeratoplasty atopic sclerokeratitis.
Conclusions
Postkeratoplasty atopic sclerokeratitis is a potentially severe complication in atopic patients undergoing keratoplasty. Systemic immunosuppression may be considered in patients with active blepharitis and corneal neovascularization.
Available online: September 27, 2007.
1Department of Ophthalmology, Tokyo Dental College, Ichikawa, Japan.
2Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
Correspondence to Shigeto Shimmura, MD, Department of Ophthalmology, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba, Japan, 272-8513.
Manuscript no. 2007-591.
No conflicting relationship exists for any author.
ABSTRACT