1. 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

2. 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

3. 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

4. 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

5. 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 mm.
ASCRS/ ASOA
SYMPOSIUM ON CATARACT, IOL AND REFRACTIVE SURGERY
San Francisco, California
April 3–8, 2009

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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