title: Monitoring the appositions of posterior graft-host junctions with anterior segment optical coherence tomogram after penetrating keratoplasty.
abstract: This study aimed to monitor the graft-host junction's (GHJ's) apposition with anterior segment optical coherence tomogram after penetrating keratoplasty (PK) and correlate the analysis with the preoperative diagnosis. Fifty-one eyes of 50 patients with various preoperative diagnosis of adherent leucoma, pseudophakic bullous keratopathy, corneal opacity or scarring, graft failure, corneal dystrophy and anterior staphyloma, who underwent PK for optical purposes were reviewed retrospectively. Based on the age, the patients were divided into groups 1 and II: those aged ≤40 and >40 years, respectively. Anterior segment optical coherence tomography was done for all these eyes to evaluate the posterior graft-host junction. All graft-host junction patterns were classified as well apposed, and malapposed with various components like hill, gap, step and tag. The comparisons of various clinical parameters were done for the various malapposed junction groups (hill, gap, step and tag). A total of 408 graft-host junction cross sections of 51 eyes were analysed. Amongst them 70 (17.15 %) sections were well apposed, and 338 (82.84 %) were malapposed. Most frequent type of malapposition was hill: 164 sections (40.19 %) followed by step: 139 sections (34.06 %). The distribution of graft-host junction alignment patterns varied amongst all the indications. Patients with preoperative diagnosis of adherent leucoma and corneal dystrophy had predominantly steps pattern in 65 (40.62 %) and 12 (75 %) sections, respectively. Hill pattern was seen predominantly in PBK, corneal opacity, graft failure and anterior staphyloma in 55 (42.96 %), 16 (40 %), 22 (45.83 %) and 8 (50 %) sections, respectively. Comparisons of various clinical characteristics like intraocular pressure, central corneal thickness, best-corrected visual acuity, astigmatism and size of graft with the various malapposed patterns showed significant differences in best-corrected visual acuity and keratometric astigmatism in the hill pattern of malapposition group with p values of .004 and .053, respectively, using independent T test. Posterior graft-host junction analysis with anterior segment optical coherence tomography is very important for post penetrating keratoplasty management. The posterior wound profile differed according to the indications of penetrating keratoplasty. Best-corrected visual acuity and keratometric astigmatism showed significant difference with the malapposition hill (pattern).
authors.affiliation: Department of Ophthalmology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, India. dranuradha_sagar@yahoo.com.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Raj
authors.affiliation: Department of Ophthalmology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, India.
authors.forename: Renu
authors.initials: R
authors.lastname: Dhasmana
authors.affiliation: Department of Ophthalmology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, India.
authors.forename: Harsh
authors.initials: H
authors.lastname: Bahadur
authors.affiliation: Department of Ophthalmology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, India.
authors.forename: R C
authors.initials: RC
authors.lastname: Nagpal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000869:Anterior Eye Segment / Q000000981:diagnostic imaging*; D003316:Corneal Diseases / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012029:Refraction, Ocular / Q000502:physiology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult
keywords: Adherent leucoma; Anterior segment optical coherence tomography; Indications; Malapposition