Original ArticlesThree-year clinical outcome after penetrating keratoplasty for keratoconus with the guided trephine system
Section snippets
Methods
We prospectively evaluated the data of consecutive keratoconus eyes that had not been previously operated on and in which keratoplasty was performed by one surgeon (Dr Skorpik) at the University Hospital of Vienna between 1993 and 1995. The patients were selected for surgery if visual acuity was no longer satisfactory to them, either with contact lenses or spectacles, moreover if correction with contact lenses also became impossible. Donor material was stored in Optisol media at 4 C. All the
Results
Thirty-nine patients (39 eyes) after keratoplasty for keratoconus with the guided trephine system were followed for at least 3 years. Four patients were excluded because of inadequate follow-up. The refractive outcome of four other patients could also not be evaluated. Of these four, one had a primary graft rejection and needed an immediate retransplantation, one had a severe eye injury 13 months after surgery, and two had refractive surgery before the 3-year follow-up. Thus, 31 patients (31
Discussion
Visual rehabilitation with low and stable postoperative astigmatism is the major goal of penetrating keratoplasty. Low astigmatism and optical stability permit easy correction with spectacles or contact lenses, which is of primary concern to patients. Postoperative astigmatism, refractive changes, and residual myopia are still significant problems in the management of patients with keratoconus after penetrating keratoplasty. The causes of postoperative astigmatism are multifactorial.5, 6, 7, 8,
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Cited by (32)
Histopathological study of 49 cases of keratoconus
2008, PathologyChanges in corneal power and refraction due to sequential suture removal following nonmechanical penetrating keratoplasty in eyes with keratoconus
2006, American Journal of OphthalmologyCitation Excerpt :Similar results were obtained for eyes with double running and interrupted running sutures.9 In addition, Ruhswurm and associates20 studied the long-term clinical outcome after keratoplasty with the guided trephine system in 31 eyes with keratoconus. They found a myopic shift associated with a steepening of the cornea (P = .008) and a low decrease of astigmatism after suture removal.
Spontaneous long-term changes of corneal power and astigmatism after suture removal after penetrating keratoplasty using a regression model
2005, American Journal of OphthalmologyCitation Excerpt :Small amounts of central flattening and increased astigmatism may be explained by the irregular bulging of the keratoconic recipient rim allowing the graft-host-junction to act like a hinge thus leaving the graft center less curved.23 Additionally, Ruhswurm and associates24 studied the long-term clinical outcome after keratoplasty with the guided trephine system in 31 eyes with KC. They found a myopic shift associated with a steepening of the cornea (P = .008) and a low decrease of astigmatism after suture removal.
Keratoconus: Current surgical options
2005, Journal Francais d'OphtalmologieShortterm and longterm visual and astigmatic results of an opposing 10-0 nylon double running suture technique for penetrating keratoplasty
2003, Journal of the American College of SurgeonsChanges of axial length and keratometry after keratoplasty for keratoconus using the guided trephine system
2002, American Journal of OphthalmologyCitation Excerpt :However, in patients with axial myopia, considerable residual myopia may remain. Continuously increasing myopia after keratoplasty in keratoconus eyes has been described by several authors,14,25,27 but the causes are still a matter of debate. In our previous study in which we evaluated the refractive results 3 years after keratoplasty for keratoconus patients with the GTS, we observed a significant gradual steepening of the cornea with time associated with myopic shift.