[Therapeutic hydrophilic bandage lenses after perforating keratoplasty in severe XXXX ].

@entity1 @entity1066 @entity2070 @entity2543 @entity936 @entity11350
BACKGROUND: The prognosis of penetrating keratoplasty after severe @entity11350 is uncertain. Beside of immune reactions the outcome is determined by surface problems. @entity1 AND METHODS: Between July 1991 and October 1993 in 15 @entity1 (16 eyes) with grade @entity11350 penetrating keratoplasties with large diameters (11-16 mm) were carried out. Cultured corneas were used with an intact epithelium. In 9 eyes hydrophilic bandage lenses (Geaflex 70, Fa. W  hlk, Kiel) were applied initially, in the remainder 7 eyes within 7 days postoperatively. RESULTS: The lens radius best suited was found out by trial, because corneal topography was not possible for many weeks. In 12 (75%) eyes the lens had to be fitted steep, with a radius from < or = 8.7. A change in lens radius during the healing course was rare. The frequent use of artificial tear drops was important, because many eyes showed clinical manifestations of @entity936 . Complications during soft contact lens wearing were rare. In 5 eyes microbiological examination was positive, but successfully treated. Under the protection of soft contact lenses 9 eyes maintained an intact epithelium. In the remainder eyes severe vascularisation with large persistent @entity2543 occurred mostly as a consequence of immune reactions. These keratoplasties developed on growth of inflammatory @entity2070 or progressive @entity1066 . The average of the follow-up time was 22 months. CONCLUSION: The use of large diameter keratoplasties in combination with hydrophilic bandage lenses proved to be successful to maintain the integrity of the epithelium in these high-risk keratoplasties. The prognosis of these transplants is, however, determined by immune reactions.
