title: Small, overlapping tectonic keratoplasty involving graft-host junction of penetrating keratoplasty.
abstract: OBJECTIVE
  To report the indications for and postoperative course of small tectonic keratoplasties overlapping (and involving) the graft-host junction of preexisting penetrating keratoplasties.
  
  
  METHODS
  A retrospective study of 15 consecutive eyes (15 patients) with small tectonic keratoplasties overlapping the graft-host junction of preexisting penetrating keratoplasties.
  
  
  RESULTS
  After tectonic keratoplasty, follow-up times ranged from 5 months to 20 years (mean, 69 months). Clinical indications included sterile corneal ulceration (seven cases), bacterial keratitis (six cases), and fungal keratitis (two cases). In the six cases with bacterial keratitis, five were suture abscesses, with four resulting in wound dehiscence. Ten tectonic grafts were lamellar keratoplasties, and five were penetrating keratoplasties. Postoperative best-corrected visual acuities were unchanged from preoperative levels in every patient. After tectonic grafting, the mean +/- SD change in keratometric astigmatism in the parent penetrating keratoplasty was 1.75 +/- 1.50 diopters. The astigmatism increased in 10 cases, decreased in three, and remained unchanged in two. There was no case of recurrent ulceration or wound dehiscence in or around the tectonic grafts. The surgery did not result in new glaucoma or worsening of preexisting glaucoma.
  
  
  CONCLUSIONS
  In the treatment of infectious or ulcerative foci at or near the graft-host junction of penetrating keratoplasties, a small extirpative, tectonic graft over the diseased junction appears to be a safe and effective alternative to either repeating the original penetrating keratoplasty or performing an oversize transplant.
authors.affiliation: W.K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan 48105, USA. hksoong@umich.edu
authors.forename: H K
authors.initials: HK
authors.lastname: Soong
authors.forename: R F
authors.initials: RF
authors.lastname: Meyer
authors.forename: A
authors.initials: A
authors.lastname: Sugar
mesh_terms: D000328:Adult; D000368:Aged; D003315:Cornea / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D003320:Corneal Ulcer / Q000209:etiology / Q000601:surgery*; D015818:Eye Infections, Bacterial / Q000150:complications / Q000601:surgery*; D015821:Eye Infections, Fungal / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome