High-Risk Corneal Transplantation

Abstract

This chapter focuses on endeavors to perform keratoplasties to treat eyes in high-risk settings and discusses alternative approaches (such as lamellar strategies). The historical and molecular backgrounds (histocompatibility antigens) as well as associated risk factors (corneal neovascularization, ocular surface pathologies, re-keratoplasty, the size of a corneal graft, intraocular surgery, anterior segment inflammation, herpes simplex, patient age) are explained. Postoperative management includes treatment of herpes simplex, systemic treatment in highrisk settings and donor tissue selection with human leukocyte antigen matching. Lamellar keratoplasties are discussed as alternatives to conventional penetrating keratoplasties. The advantages and disadvantages of both anterior and posterior lamellar keratoplasties are highlighted.