BACKGROUND:Comeal graft endothelial cell density may decline spontaneously at a super-physiological speed after penetrating keratoplasty (PKP),even if no corneal rejection happens,and this is chronic corneal allograff dysfunction (CCAD).OBJECTIVE:To investigate the effects of topical corticosteroid treatment on chronic corneal allograft dysfunction after PKP.DESIGN,TIME AND SETTING:A controlled clinical analysis was performed at the Department of Ophthalmology,Tongji Hospital,Tongji University from May 2004 to May 2009.PARTICIPANTS:A total of 54 patients (eyes) who underwent PKP were included in this study.METHODS:Tobramycin-dexamethasone eyedrops was applied 6 times per day as an initial dosage and tapered during 4 months.Thereafter,drug withdrawal group and long term group were randomly divided.Treatments were ceased in the drug withdrawal group but were continued in the long-term group with a dosage of twice per day till 12 months after surgery.MAIN OUTCOME MEASURES:Corneal graft endothelial cell density was followed up.The mean follow up pedod was 3.12±0.28years.RESULTS:The corneal graft endothelial cell density of drug withdrawal and long term groups was dramatically declined within 36 months after PKP.At every time point,the endothelial cell density was significantly decreased compared to the last follow up (all P＜0.01 ).The endothelial cell density was decreased from (2 428±2.11) cells/mm~2 and (2 791±2.29) cells/mm~2 to (1 424±124) cells/mm~2 and (1 614±114) cells/mm~2 in the drug withdrawal and long-term groups,respectively.There was significant difference in endothelial cell density between the two groups no matter prior to surgery or at each time points after surgery,but the declination trends of two groups were basically the same,indicating that graft loss of endothelial cell density was not impacted by topical corticosteroid treatment after PKP (P＞0.05).CONCLUSION:Chronic corneal allograft dysfunction after PKP is independent of topical corticosteroid treatment.

Objective To observe the clinical effects of a new method:non-optic nerve transecring evisceration combined with first stage hydroxyapatite orbital implantation.Methods One hundred and twenty two eyes (122 cases) were randomly divided into group A and group B,evisceration was first undertaken,the scleral wall was superior-temporally to inferior-nasally dissected and double scleral petals were placed before the implanted hydroxyapatite artificial eyeball.The difference between group A and group B was:in group A,the optic nerve was transected behind the eyeball,but in group B,a 2 mm outside the optic nerve scleral circle cutting was taken.Hemostasis time before implantation,tensile force during conjunctival suture,pain during surgery,palpebral fissure height after eye speculum wearing,operation time consuming,pain after surgery,conjunctival edema and congestion,and ocular prosthesis wearing time were compared between the two groups.Results In groups A and B,the intra-operative hemostasis time were (23.46 ± 6.96)mins and (5.49 ± 1.72)mins,the tensile force score during conjunctiva suture were 3.39±0.74 and 0.45±0.59,the score of pain in the first day were 2.8 ±0.68 and 1.47 ± 0.67,the ocular prosthesis wearing time after surgery were (6.27±2.73) and (3.07 ± 2.11)weeks,respectively.The differences of all the parameters above were with statistical significance between groups A and B (P＜0.01).During 2 years follow-up,no complications such as orbital implant exposure or infection happened.Conclusions Compared to traditional methods,the non-optic nerve transecting evisceration method has merits of less impairment,short time-consuming,less pain,and quicker postoperative recovery.