PK a high-risk procedure in mustard gas keratitis patients

Penetrating keratoplasty performed in patients with chronic or delayed-onset mustard gas keratitis should be considered a high-risk graft, according to a study by researchers in Iran. "However, with appropriate management, graft clarity and visual outcomes may be favorable," the study authors said.

Mohammad Ali Javadi, MD, and colleagues evaluated the long-term outcomes of PK performed between 1989 and 2006 on 22 eyes of 19 war victims with advanced chronic or delayed mustard gas keratitis. They published their results in the October issue of Cornea.

Patients averaged 41 years of age at surgery and were followed for an average of 40.9 months postop.

Grafts remained clear in 17 eyes (77.3%) and failed in five eyes (22.7%), the authors reported.

For all eyes, best corrected visual acuity averaged 1.92 logMAR preoperatively and improved to 1.04 logMAR after surgery. In particular, BCVA significantly improved over baseline among eyes with grafts that remained clear and averaged 0.8 logMAR postoperatively (P < .001), according to the study.

Overall, 13 eyes (59.1%) experienced episodes of endothelial rejection. Another five eyes (22.7%) had subepithelial immune rejection, with four of these eyes also experiencing simultaneous endothelial rejection, according to the study.

Fourteen eyes (63.6%) developed cataracts, seven of which received cataract surgery. Another one eye developed steroid-induced glaucoma after experiencing multiple graft rejection episodes, the authors reported.