The S. Fyodorov EYE MICROSURGERY STATE INSTITUTION, Moscow, Russia, Ekaterinburg S-Petersburg Tambov Novosibirsk Kaluga Cheboksary Orenburg Irkutsk Khabarovsk Volgograd Krasnodar ASCRS/ ASOA SYMPOSIUM ON CATARACT, IOL AND REFRACTIVE SURGERY San Francisco, California April 3–8, 2009

Long-term Graft Survival after Primary Penetrating Low- Risk Keratoplasty Olga Kravchuk, M.D., Ph.D. professor Valentina Kopayeva, M.D., Ph.D., Dr. Med. Sc. ASCRS/ ASOA SYMPOSIUM ON CATARACT, IOL AND REFRACTIVE SURGERY San Francisco, California April 3–8, 2009 Financial interest disclosure: None

Purpose of the study To report long – term graft survival rates for penetrating keratoplasty (PKP) ASCRS/ ASOA SYMPOSIUM ON CATARACT, IOL AND REFRACTIVE SURGERY San Francisco, California April 3–8, 2009

Materials/ Methods Retrospective, noncomparative case series Review of 272 consecutive eyes that underwent PKP at a final referral center in Russian Federation since 1975 Data collected retrospectively from May 1975 through November 1988 and prospectively thereafter ASCRS/ ASOA SYMPOSIUM ON CATARACT, IOL AND REFRACTIVE SURGERY San Francisco, California April 3–8, 2009

Materials/ Methods Inclusion criteria: the underlying pathology - keratoconus (82 eyes, 30 %), post inflammatory disease (92 eyes, 33 %), pseudophakic bullous keratopathy (63 eyes, 23 %) and dystrophies (35 eyes, 14 %). Only primary low-risk grafts were included in the trial All patients underwent penetrating keratoplasty To reduce postoperative astigmatism patented graft marking method (V. Kopayeva, 1982) was incorporated with disc diameter 7.0- 9.0 mm. ASCRS/ ASOA SYMPOSIUM ON CATARACT, IOL AND REFRACTIVE SURGERY San Francisco, California April 3–8, 2009

Graft marking method surgical steps (V. Kopayeva, 1982) 1 Transparent template application on recipient cornea. Determination of the cornea center Marking of the cornea center Application of the marker device ASCRS/ ASOA SYMPOSIUM ON CATARACT, IOL AND REFRACTIVE SURGERY San Francisco, California April 3–8, 2009

Graft marking method surgical steps (V. Kopayeva, 1982) 2 Marking of the trephination zone and of four main meridians on the recipient cornea Setting of the trephine on the marked trephination zone and checking of the correct setting as judged by the adjustment of the marks on the trephine and the cornea Recipient disc removal ASCRS/ ASOA SYMPOSIUM ON CATARACT, IOL AND REFRACTIVE SURGERY San Francisco, California April 3–8, 2009

Graft marking method surgical steps (V. Kopayeva, 1982) 3 Graft placed onto the wound bed of the recipient cornea. The marks on the corneas of the donor and the recipient are precisely adjusted Fixation of the graft by four interrupted sutures strictly along by the adjusted marks Fasterning of the graft by continuous suture. Interrupted sutures removed ASCRS/ ASOA SYMPOSIUM ON CATARACT, IOL AND REFRACTIVE SURGERY San Francisco, California April 3–8, 2009

Results Mean recipient age was 42 years (24 – 72) Almost all patients had visual acuity sufficient for reading 180 patients reached UCVA 10/20. Postoperative astigmatism noted in 32 % cases within 0.5 – 2.5 D, in 68% -within 4.0 D ASCRS/ ASOA SYMPOSIUM ON CATARACT, IOL AND REFRACTIVE SURGERY San Francisco, California April 3–8, 2009

Results 11 cases of secondary graft failure (4%) registered Survival of the first time grafts was 98.9 % at 5 years, 98.0% at 10 years, 98.0 % at 20 years and 96.0 % at 30 years after PKP Regrafting was done due to secondary graft failure, trauma, herpetic keratitis recurrence ASCRS/ ASOA SYMPOSIUM ON CATARACT, IOL AND REFRACTIVE SURGERY San Francisco, California April 3–8, 2009 Secondary graft failure 12 months after primary low –risk PKP

Conclusions There is limited number of publications on graft survival with a follow – up longer than 10 years The long-term survival rates demonstrate that PKP is safe and effective treatment in corneal diseases transplanted in Russia and prove possibility to maintain clear graft over long term with minimal postoperative astigmatism Despite low risks of graft failure in uncomplicated eyes rejection possibility substantiates follow – up over whole life span ASCRS/ ASOA SYMPOSIUM ON CATARACT, IOL AND REFRACTIVE SURGERY San Francisco, California April 3–8, 2009