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Retrocorneal fibrous membranes in failed corneal grafts
I Kremer1, C J Rapuano, E J Cohen
1Cornea Service, Wills Eye Hospital, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107.
Abstract:
Histopathologic slides from 170 failed grafts, excised between 1983 and 1990 were reviewed. The overall incidence of retrocorneal fibrous membrane was 54% (92 grafts). The incidence of diffuse (extensive) retrocorneal fibrous membrane was 17% (29 grafts) and that of focal (peripheral) retrocorneal fibrous membrane was 37% (63 grafts). A high correlation was found between the clinical presence of peripheral anterior synechiae or vitreous adherent to the wound and the finding of retrocorneal fibrous membrane in aphakic and pseudophakic failed corneal grafts. A high correlation was also found between tube-shunt operation and the presence of diffuse retrocorneal fibrous membrane. Sixteen of 63 (25%) regrafted failed grafts, that is second grafts, with focal retrocorneal fibrous membranes failed within 18 months following surgery. Thirteen of 29 (45%) regrafted failed grafts with diffuse retrocorneal fibrous membrane failed within the same period and 11 of these (85%) were associated with tube-shunt surgery.
Insights
Retrocorneal fibrous membrane affects over half of failed corneal grafts. This membrane, especially diffuse types linked to tube-shunt surgery, significantly increases the risk of subsequent graft failure.
Area of Science:
- Ophthalmology
- Histopathology
- Corneal Transplantation
Background:
- Retrocorneal fibrous membrane (RCFM) is a known complication following corneal transplantation.
- Its precise incidence and correlation with specific surgical factors in failed grafts require further elucidation.
Purpose of the Study:
- To investigate the incidence of retrocorneal fibrous membrane in failed corneal grafts.
- To determine the correlation between RCFM and clinical findings, including graft type and previous surgical interventions.
Main Methods:
- Histopathologic review of 170 failed corneal grafts excised between 1983 and 1990.
- Classification of RCFM into diffuse and focal types.
- Correlation analysis with clinical data such as peripheral anterior synechiae, vitreous adherence, and tube-shunt operations.
Main Results:
- Overall incidence of RCFM was 54% (92/170 grafts).
- Diffuse RCFM occurred in 17% (29/170) and focal RCFM in 37% (63/170) of grafts.
- High correlation found between RCFM and peripheral anterior synechiae or vitreous adherence in aphakic/pseudophakic grafts.
- Tube-shunt surgery showed a high correlation with diffuse RCFM.
- Regrafted grafts with focal RCFM had a 25% failure rate within 18 months, while those with diffuse RCFM had a 45% failure rate, with 85% of the latter associated with tube-shunt surgery.
Conclusions:
- Retrocorneal fibrous membrane is a common finding in failed corneal grafts.
- Diffuse RCFM, particularly when associated with tube-shunt surgery, is linked to a higher risk of early regraft failure.
- Clinical factors like peripheral anterior synechiae and vitreous adherence are associated with RCFM presence.