title: Ocular surface deficits contributing to persistent epithelial defect after penetrating keratoplasty.
abstract: OBJECTIVE
  To determine the ocular surface deficits contributing to persistent epithelial defect (PED) after penetrating keratoplasty (PKP).
  
  
  METHODS
  Four ocular surface deficits that contribute to PED and their corrective measures were reviewed in 11 eyes of 11 patients with PED after PKP.
  
  
  RESULTS
  Among these 11 eyes, PED developed early in 8 eyes and late in 3 eyes after PKP. They all had more than 2 ocular surface deficits, with infrequent blinking (11 eyes) and lagophthalmos (9 eyes) being more common. Proper corrective measures resulted in rapid epithelialization in 1 week (1 eye), 2 weeks (9 eyes), and 3 weeks (1 eye) via insertion of a bandage contact lens to maintain tear film for treating infrequent blinking (4 eyes), tarsorrhaphy to correct nocturnal lagophthalmos (2 eyes), and fornix reconstruction to eliminate pathogenic symblepharon (4 eyes). During the follow-up of 22.1 ± 7.6 months after healing of PED, 8 eyes retained a stable and clear graft, whereas 3 eyes with more ocular surface deficits had recurrent PED and graft failure develop. Two of the latter were corrected by a repeat PKP combined with oral mucosal graft to correct the remaining cicatricial eyelids.
  
  
  CONCLUSIONS
  Besides the neurotrophic state and aqueous tear deficiency dry eye common in this cohort, infrequent blinking, lagophthalmos, and pathogenic symblepharon also contribute to PED after PKP. Proper corrective measures and vigilant follow-up are crucial for maintaining PKP graft survival in these severe cicatricial ocular surface diseases.
authors.affiliation: Department of Ophthalmology, Ninth People's Hospital, Medical School of Shanghai Jiaotong University, Shanghai, China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Fu
authors.forename: Jingbo
authors.initials: J
authors.lastname: Liu
authors.forename: Scheffer C G
authors.initials: SC
authors.lastname: Tseng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001767:Blinking; D003316:Corneal Diseases / Q000209:etiology* / Q000601:surgery; D015352:Dry Eye Syndromes / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D019573:Epithelium, Corneal / Q000473:pathology*; D005141:Eyelid Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015948:Keratoplasty, Penetrating; D007766:Lacrimal Apparatus Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D013508:Ophthalmologic Surgical Procedures; D019919:Prosthesis Implantation; D012189:Retrospective Studies
chemical_list: D009883:Ophthalmic Solutions