Background: The prognosis of penetrating keratoplasty after severe eye burns is uncertain. Beside of immune reactions the outcome is determined by surface problems.
Patients and methods: Between July 1991 and October 1993 in 15 patients (16 eyes) with grade IV eye burns 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. Wöhlk, 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 dry eye syndrome. 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 epithelial defects occurred mostly as a consequence of immune reactions. These keratoplasties developed on growth of inflammatory pannus or progressive ulceration. 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.