1. Management of Failed Penetrating Keratoplasty: A New OCT-Based Protocol
Jatin Ashar1
1Mumbai Eye Care, Cornea and LASIK Centre
1The Perfect Vision Laser LASIK Centre
NO FINANCIAL DISCLOSURES

2. Introduction
Management options for failed penetrating keratoplasty include repeat penetrating keratoplasty, Descemet’s stripping endothelial keratoplasty or keratoprosthesis
Management of failed penetrating keratoplasty is technically challenging and numerous issues have to be addressed related to the type of surgery, prediction of surgical surprises, graft size and need of additional surgery
A pre operative evaluation using anterior segment OCT may help in avoiding complications and improving outcomes

3. Purpose Material & Methods
To evaluate the role of Anterior OCT in management of failed graft
440 graft host sections of 55 failed grafts were analyzed using AS-OCT(Visante, Carl Zeiss, Germany)
Malapposition were categorized as gapes, graft or host steps, ledge, protrusion hills or tags
Material & Methods

4. Results
Smooth posterior graft host junction (3) allowed larger or same size DSEK/PK graft
Anterior malapposition(3) necessitated repeat PK
Irregular posterior wound malaaposition 17 cases (2 step, 1 protrusion, 1 gap, 13 ledge) needed larger PK/ smaller DSEK graft
Extensive synechiae >180 degrees in 3 cases and less than 180 degrees synechiae were noted in 4 cases

5. Graft Sizing Graft size same as previous graft Case 1: 60/M
Keratoplasty for corneal scar 4 years back
Graft failure secondary to graft rejection
Plan: Repeat keratoplasty
Case 2: 71/F
Keratoplasty Graft failure
Plan: Repeat keratoplasty

6. Graft Sizing Graft size smaller than previous graft 32/F
Operated large PK 8 months back, Failed graft with PED

7. 67/M
Operated PK followed by cataract surgery elsewhere
Graft larger than previous PK

8. Conclusion
AS OCT provides useful information about the graft host junction and anterior chamber structures after PK that may be useful in anticipation of problems during repeat surgery (DSEK/PK) (need for synechiolysis, available space in the anterior chamber for DSEK, glaucoma device placement and need for glaucoma surgery), graft sizing (step, ledge configurations- smaller/same sized DSEK graft, smooth configuration- larger sized DSEK graft)/ malapposed posterior wound –avoid smaller repeat graft