CHALLENGES IN IMMEDIATE AND LONG-TERM POSTOPERATIVE MANAGEMENT IN PATIENTS WITH CORNEAL TRANSPLANT
Abstract
Corneal transplantation is a procedure involving the partial or total replacement of a damaged cornea with a healthy one, serving multiple purposes such as improving visual acuity, for aesthetic reasons, and for tectonic support. The most common procedure used in our clinic is penetrating keratoplasty, which can be burdened with a series of intraoperative and postoperative complications. The aim: In this article, we will present our clinic’s experience with patients who have undergone and been diagnosed with corneal pathologies through penetrating keratoplasty technique, and the medium and long-term therapeutic difficulties encountered by these patients from 2020 to 2024, at the Ophthalmology Clinic of “Sf. Spiridon” County Clinical Emergency Hospital Iasi. Materials and methods: Patients with a history of chemical burns to the cornea, herpetic infection, keratoglobus associated with lagophthalmos, chronic smokers, and those with advanced pseudoexfoliative glaucoma in one eye are included. Results: Among the postoperative complications, infections and rejection reactions can occur between 2 weeks and 8 months and are quite challenging to manage. Postoperative infections can be present due to non-conforming sutures, prolonged use of contact lenses, and systemic immunosuppression. Rejection reactions can occur as early as two weeks, with corneal vascularization in the host cornea increasing the risk of graft rejection. Early identification and prompt treatment of inflammation and early infection are facilitating factors in preventing graft rejection. Conclusions: Although, in terms of survival, corneal transplantation is the most successful transplant performed in humans, rejection is still the main cause responsible for graft failure. Keratoplasty involves a lengthy healing process; preoperative evaluation and dialogue with the patient are essential to understand the benefits, possible complications, and the need for prolonged treatment.
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