Long-term outcomes of penetrating keratoplasty in chronic and delayed mustard gas keratitis.
OBJECTIVE
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.
Javadi
Mohammad Ali
MA
Department of Ophthalmology, Labbafinejad Medical Center, Shaheed Beheshti Medical University, Tehran, Iran. ma_javadi@yahoo.com
Yazdani
Shahin
S
Kanavi
Mozhgan Rezaei
MR
Mohammadpour
Mehrdad
M
Baradaran-Rafiee
Alireza
A
Jafarinasab
Mohammad Reza
MR
Einollahi
Bahram
B
Karimian
Farid
F
Zare
Mohammad
M
Naderi
Mostafa
M
Rabei
Hossein Mohammad
HM
D000328:Adult; D002057:Burns, Chemical / Q000473:pathology / Q000601:surgery*; D002619:Chemical Warfare Agents / Q000009:adverse effects*; D002908:Chronic Disease; D005126:Eye Burns / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007493:Iraq; D007634:Keratitis / Q000139:chemically induced / Q000473:pathology / Q000601:surgery*; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D009151:Mustard Gas / Q000009:adverse effects*; D016896:Treatment Outcome; D014792:Visual Acuity; D014857:Warfare
D002619:Chemical Warfare Agents; D009151:Mustard Gas