Long-term Outcomes of Penetrating Keratoplasty in Chronic and Delayed Mustard Gas Keratitis

Department of Ophthalmology, Labbafinejad Medical Center, Shaheed Beheshti Medical University, Tehran, Iran.
Cornea (Impact Factor: 2.04). 10/2007; 26(9):1074-8. DOI: 10.1097/ICO.0b013e3181334752
Source: PubMed


To report the long-term outcomes of penetrating keratoplasty (PKP) in war victims with chronic and delayed mustard gas keratitis.
This noncomparative interventional case series includes patients with advanced chronic or delayed mustard gas keratitis who had undergone PKP from 1989 to 2006. Best-corrected visual acuity (BCVA), graft clarity, episodes of graft rejection, duration of steroid use, and complications were evaluated. Histopathologic features of excised corneal buttons were also evaluated.
Overall, 22 eyes of 19 patients underwent PKP. Mean age at the time of surgery was 41 +/- 4.6 years (range, 36-54 years), and mean follow-up duration was 40.9 +/- 48 months (range, 4-204 months). The graft remained clear in 17 (77.3%) eyes and failed in 5 (22.7%) eyes. Overall, 13 (59.1%) eyes experienced episodes of endothelial rejection, and 5 (22.7%) eyes had subepithelial immune rejection, 4 of which had simultaneous endothelial rejection. Fifteen (68.2%) eyes received topical steroids for >6 months. Fourteen (63.6%) eyes developed cataracts, leading to cataract extraction in 7 eyes. One eye developed steroid-induced glaucoma after multiple episodes of endothelial graft rejections. Mean preoperative BCVA was 1.92 +/- 0.63 logMAR, which improved to 1.04 +/- 0.65 logMAR (20/200) overall and 0.8 +/- 0.3 logMAR (20/120) in eyes with clear grafts (P < 0.001). Main histopathologic features of excised corneal buttons included corneal thinning and ulceration, loss of keratocytes, acute and chronic inflammation, stromal vascularization, and degenerative sequelae of long-standing inflammation.
PKP in chronic or delayed-onset mustard gas keratitis should be considered as a high-risk graft; however, with appropriate management, graft clarity and visual outcomes may be favorable.

7 Reads
  • Source
    • "Therefore, PK in chronic or delayed-onset mustard gas keratitis should be considered as a high-risk graft. However, with appropriate management, graft clarity and visual outcomes may be favorable (Javadi et al., 2007). Gradual progression of corneal involvement is observed and bilateral limbal changes with tortuous blood vessels and full-thickness corneal alterations have progressed toward ischemic and white episcleral changes and adjacent peripheral ulcerative keratopathy. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This review describes the evaluation of acute and chronic systemic and ocular toxic effects of sulfur mustard (SM) on exposed humans. It is intended to increase the awareness of extensive and dangerous environmental hazards of this agent and describe different treatment modalities for systemic and ocular involvement. Historical information and current events were accessed through the internal and external military field manuals and Internet searches. We reviewed the history, mechanism of action, and clinical and treatment modalities relating to ocular involvement of SM poisoning, by accident, terrorism, or war exposure. SM is the most dangerous organochlorine vesicant agent, which alkylates DNA. In liquid or gas form, its main targets are the eyes, skin, and lungs. Clinical effects are like burns accompanied by loss of immunity, respiratory failure, and ophthalmic, gastrointestinal, and hematological signs. Ocular effects of SM differ in acute and chronic toxicity. There are no specific antidotes for SM poisoning; hence, preventive medicine and modalities are paramount. So the first and most efficient treatment is to remove and decontaminate the victims. Most of the acute ocular problems heal during a few weeks after exposure, but rare regression of the signs and symptoms can occur up to more than 20 years after exposure, the so-called delayed keratitis that may lead to an uncontrolled penetrating keratoplasty and blindness.
    Toxin Reviews 01/2009; 28(1):14-23. DOI:10.1080/15569540802689279 · 0.65 Impact Factor
  • Source

  • [Show abstract] [Hide abstract]
    ABSTRACT: This chapter describes the consequences of sulfur mustard (SM) exposure to the eyes and their treatments. Corneal SM exposure causes injuries that range from mild conjunctivitis to advanced corneal disease. As a warfare agent, SM is extremely effective because even mild ocular exposure causes some visual incapacitation and a panic and fear of blindness whose psychological impact cannot be underestimated. As for clinical symptoms, extensive military data have documented that the effects of SM vary widely according to the exposure time and concentration of the vesicant, as well as individual susceptibility. Most descriptions of the degree of ocular injury in humans characterize the phenotypes into three classes, each being a variant of mild, moderate, or severe. One of the worst consequences of SM exposure is corneal perforation. This effect can occur many weeks after exposure, and animal data are beginning to suggest that treatments for SM injury may, in themselves, contribute to toxicity. There is much research being done to identify countermeasures against mustards. There are many other promising therapies for mustard exposure but still in experimental phase.
    Handbook of Toxicology of Chemical Warfare Agents, 01/2009: pages 575-594; , ISBN: 9780123744845
Show more