The Complications After Keratoplasty

Keratoplasty is the medical term that refers to a cornea transplant. There are some differences between the definitions of keratoplasty, commonly it is mentioned for corneal transplant, Lamellar Keratoplasty, which is a partial thickness corneal grafting and penetrating keratoplasty: is a full-thickness corneal grafting. The indications for keratoplasty include: optical (to improve visual acuity by replacing the opaque host tissue by a healthy donor or pesudophakic bullous keratopathy), tectonic (in patients with stromal thinning and descemetoceles, to preserves corneal anatomy ant integrity), therapeutic (removal of inflamed corneal tissue refractive to treatment by antibiotics or antiviral drugs) or cosmetic (in patients with corneal scars giving a whitish opaque hue to the cornea. The most frequent causes of corneal alterations leading to keratoplasty are keratoconus, bacterial infections, poor hygienic contact lens wear (Buehler et al. 1992, Chalupa, 1987, Holden, 2003) or trauma. Among microbial infections, bacterial infections are the most frequent and are mainly caused by Staphylococcus sp., Streptococcus sp. or Pseudomona sp. Some side effects of keratoplasty can be infection (keratitis on the new transplanted cornea or endophthalmitis), transplant rejection, vision fluctuation, glaucoma and bleeding, among others less reported. Infection is one of the most frequent complications after keratoplasty, which can cause endophthalmitis. Infection after keratoplasty, can result from inapropiate healing or like a complication during the transplant (Confino and Brown, 1985 and Dana, 1995). even though the area around the eye is completely sterilized the day of the surgery and the face is covered with sterile drapes. Despite these actions to keep the surgical area clean, infections still may occur. On the other hand, transplant rejection is one of the hardest complications after keratoplasty. It occurs when the body rejects the new cornea. But it can occur from days to several years after surgery. Symptoms that show that the immunological system has rejected the cornea may be redness of the eye, an extreme sensitivity to light and pain, autoimmune diseases, infiltrates and also unknown causes. Signs of rejection may occur anywhere from one month to several years after the transplant surgery. On these cases, keratoplasty can be repeated when the transplant is rejected and oral immunosupresor drugs must be taken for long time to reduce the rejection. Some authors are reported also vision fluctuation after keratoplasty, frequent symptoms are poor vision and fluctuations for up to several months or years. Not until the vision has reached a constant and the sutures have been removed can the individual be given a prescription for eyeglasses or special contact lenses.