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Intrastromal corneal ring segments followed by photorefractive keratectomy for high post-keratoplasty astigmatism. J Cataract Refract Surg 2022; 48:912-923. [DOI: 10.1097/j.jcrs.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 01/11/2022] [Indexed: 11/26/2022]
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Deshmukh R, Nair S, Vaddavalli PK, Agrawal T, Rapuano CJ, Beltz J, Vajpayee RB. Post-penetrating keratoplasty astigmatism. Surv Ophthalmol 2021; 67:1200-1228. [PMID: 34808143 DOI: 10.1016/j.survophthal.2021.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/06/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
Postoperative astigmatism is one of the common complications affecting visual outcomes after a penetrating keratoplasty. It can result from various factors related to host, donor and surgical technique, resulting in suboptimal visual outcome. While some of the measures taken during preoperative planning and during actual surgery can reduce the magnitude of postoperative astigmatism, postoperative correction of astigmatism is often required in cases with high degrees of astigmatism. When spectacles and contact lenses fail to provide optimal visual outcomes, various surgical techniques that include astigmatic keratotomy, compression sutures, toric intraocular lens placement, and laser refractive procedures can be considered. When none of these techniques are able to achieve a desired result with in the acceptable optical range, a repeat keratoplasty is considered a last option. We discuss the various causes and management of complication of postoperative astigmatism occurring after a full thickness corneal transplantation surgery.
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Affiliation(s)
| | - Sridevi Nair
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Tushar Agrawal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | | | - Rasik B Vajpayee
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Vision Eye Institute, Melbourne, Australia; University of Melbourne, Australia
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Sorkin N, Mimouni M, Santaella G, Kreimei M, Trinh T, Yang Y, Saeed D, Cohen E, Rootman DS, Chan CC, Slomovic AR. Comparison of manual and femtosecond astigmatic keratotomy in the treatment of postkeratoplasty astigmatism. Acta Ophthalmol 2021; 99:e747-e752. [PMID: 33124121 DOI: 10.1111/aos.14653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 09/25/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the outcomes of femtosecond astigmatic keratotomy (FSAK) and manual astigmatic keratotomy (AK) in treatment of postkeratoplasty astigmatism. METHODS A retrospective, comparative, pairwise-matched case series including 150 patients who underwent either FSAK (n = 75) or manual AK (n = 75) for the treatment of astigmatism (>3.00 D) following penetrating keratoplasty or deep anterior lamellar keratoplasty. Pairwise matching for baseline variables (age, visual acuity and astigmatism) was performed. RESULTS Mean age was 57.5 ± 16.0 years. The FSAK group had significantly better postoperative best-corrected visual acuity (BCVA) (p = 0.010), uncorrected visual acuity (UCVA) (p = 0.049), corneal astigmatism (p = 0.020) and manifest astigmatism (p < 0.001) compared with the manual AK group. Gain of ≥3 lines in BCVA (logMAR) was seen in five eyes (6.7%) and 21 eyes (28.0%) in manual AK and FSAK, respectively (p = 0.005). Alpins vector analysis showed lower (closer to 0) index of success (0.50 ± 0.24 and 0.79 ± 0.48, p < 0.001) and higher (closer to 1) correction index (0.94 ± 0.45 and 0.74 ± 0.55, p = 0.020) in FSAK compared with manual AK. Corneal and manifest astigmatism improved significantly in both groups, while BCVA and UCVA improved significantly in FSAK only. Repeat AK rate was 32% (24 eyes) in manual AK and 4% (three eyes) in FSAK (p < 0.001). Overcorrection-related re-suturing rate was 0% in manual AK and 8% (six eyes) in FSAK (p = 0.037). There was one microperforation (1.3%) in FSAK, and there were no occurrences of graft dehiscence, infectious keratitis or graft rejection. CONCLUSIONS Both manual AK and FSAK were safe and effective in reducing postkeratoplasty astigmatism. FSAK had superior visual and keratometric outcomes compared with manual AK.
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Affiliation(s)
- Nir Sorkin
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
- Department of Ophthalmology Tel Aviv Medical Center and Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Michael Mimouni
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
| | - Gisella Santaella
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
| | - Mohammad Kreimei
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
| | - Tanya Trinh
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
| | - Yelin Yang
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
| | - Danyal Saeed
- Michael G. DeGroote School of Medicine McMaster University Hamilton ON Canada
| | - Eyal Cohen
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
| | - David S. Rootman
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
| | - Clara C. Chan
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
| | - Allan R. Slomovic
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
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Factors Associated With Improvement in Vision Following Femtosecond Astigmatic Keratotomy in Post-Keratoplasty Keratoconus Patients. Am J Ophthalmol 2020; 219:59-65. [PMID: 32574774 DOI: 10.1016/j.ajo.2020.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate factors associated with improvement in vision following femtosecond astigmatic keratotomy (FSAK) in patients with keratoconus post-keratoplasty. DESIGN Retrospective, interventional case series. METHODS The study took place in an institutional setting. This was a retrospective study that included patients with keratoconus who underwent FSAK for astigmatism following penetrating (PKP) or deep anterior lamellar keratoplasty (DALK). Success was defined as improvement in 3 Early Treatment Diabetic Retinopathy Study lines (doubling of the visual angle) of uncorrected distance visual acuity (UDVA) or best spectacle-corrected visual acuity (BSCVA). RESULTS A total of 56 eyes in 56 patients with keratoconus were included. Following FSAK, there was a significant improvement in UDVA (1.30 ± 0.49 to 0.87 ± 0.58 logarithm of minimal angle of resolution [logMAR]; P < .001), BSCVA (0.40 ± 0.26 to 0.27 ± 0.29 logMAR; P <.001), and corneal astigmatism (8.69 ± 2.72 to 3.92 ± 2.13 diopter [D]; P < .001). Success was achieved in 60.7% (34/56) of cases, and this group had a higher proportion of previous PKP (73.5% vs 45.5%; P = .03), worse preoperative UDVA (1.42 ± 0.47 vs 1.11 ± 0.47 logMAR; P = .03), and a greater preoperative manifest cylinder (7.56 ± 2.26 vs 5.72 ± 2.12 D; P = .01). In multiple regression analysis, PKP (vs DALK) (odds ratio [OR]: 8.52; P = .009), worse preoperative UDVA (OR: 9.08, P = .02), and greater preoperative cylinder (OR: 1.51; P = .04) were independently associated with success, and, when combined, led to a sensitivity and specificity of 84.6% and 93.8%, respectively, in predicting success. The optimal cutoff predicting success with a preoperative cylinder was a cylinder >6.75 D. CONCLUSION Approximately 60% of patients with keratoconus post-keratoplasty experience doubling of the visual angle following FSAK. Patients with previous PKP and a greater cylinder are more likely to benefit from this procedure. Separate nomograms for DALK and PKP patients may be warranted.
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Stepwise Combination of Femtosecond Astigmatic Keratotomy With Phacoemulsification and Toric Intraocular Lens Implantation in Treatment of Very High Postkeratoplasty Astigmatism. Cornea 2019; 39:71-76. [PMID: 31490273 DOI: 10.1097/ico.0000000000002131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the outcomes of stepwise combined femtosecond astigmatic keratotomy (FSAK) and phacoemulsification with toric intraocular lens (IOL) implantation in the treatment of very high astigmatism after either penetrating keratoplasty or deep anterior lamellar keratoplasty. METHODS This is a retrospective, interventional case series including 8 eyes of 6 patients with very high astigmatism [≥8.00 diopter (D)] after either penetrating keratoplasty or deep anterior lamellar keratoplasty who underwent FSAK, followed by phacoemulsification and toric IOL implantation. Outcome measures were corneal and manifest astigmatism and uncorrected and best spectacle-corrected visual acuity (UCVA, BSCVA). RESULTS The average age was 58.9 ± 5.1 years. The average follow-up time was 40.9 ± 43.8 months. Outcome measure changes after both FSAK and toric IOL implantation were: corneal astigmatism improved from 13.56 ± 4.81 D to 4.48 ± 2.83 D (P < 0.001), manifest astigmatism improved from 9.15 ± 3.86 to 1.46 ± 0.88 D (P = 0.011), UCVA improved from 1.69 ± 0.45 LogMAR (Snellen equivalent ∼20/980) to 0.23 ± 0.11 LogMAR (Snellen equivalent ∼20/33, P < 0.001), and BSCVA improved from 1.01 ± 0.71 LogMAR (Snellen equivalent ∼20/200) to 0.19 ± 0.11 LogMAR (Snellen equivalent ∼20/30, P = 0.015). BSCVA and UCVA at the last follow-up were 20/40 or better in all patients. All procedures were uneventful. Two eyes underwent photorefractive keratectomy after FSAK to regularize and further reduce astigmatism before toric IOL implantation. One patient underwent temporary compression suturing because of FSAK overcorrection. CONCLUSIONS Combined stepwise use of FSAK and phacoemulsification with toric IOL implantation was an effective and apparently safe approach in patients with very high postkeratoplasty astigmatism. Additional treatment using photorefractive keratectomy may be beneficial in some cases.
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Wavefront-Guided Photorefractive Keratectomy in the Treatment of High Astigmatism Following Keratoplasty. Cornea 2018; 38:285-289. [DOI: 10.1097/ico.0000000000001830] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ho Wang Yin G, Hoffart L. Post-keratoplasty astigmatism management by relaxing incisions: a systematic review. EYE AND VISION 2017; 4:29. [PMID: 29238735 PMCID: PMC5725940 DOI: 10.1186/s40662-017-0093-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 11/26/2017] [Indexed: 12/02/2022]
Abstract
Postoperative visual acuity can be limited by post-keratoplasty astigmatism, even with a clear corneal graft. Astigmatism management can be performed by selective suture removal, adjustment of sutures, optical correction, photorefractive procedures, wedge resection, intra-ocular lens implantation, intracorneal ring segments, relaxing incisions with or without compression sutures and repeated keratoplasty. Relaxing incisions can be made in the graft, graft-host interface or host cornea. Despite the unpredictability of the method because the flat and steep meridians are usually not orthogonal after penetrating keratoplasty, with asymmetric power distribution, all the studies showed an overall reduction of refractive, keratometric or topographic astigmatism, ranging from 30% to 72% with manual or femtosecond-assisted techniques. Most patients with astigmatism higher than 6 diopters had residual cylinder less than or equal to 3 diopters, which can be treated by laser excimer ablation or secondary intraocular lens implantation.
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Affiliation(s)
- Gaëlle Ho Wang Yin
- Ophthalmology Department, Aix-Marseille University - APHM, Hôpital de la Timone, 264 rue Saint Pierre, 13 385 Marseille Cedex 5, France.,Institut Fresnel UMR 7249, Aix Marseille Université, CNRS, Centrale Marseille, Domaine universitaire de Saint-Jérôme Avenue Escadrille Normandie Niemen, 13397 Marseille cedex 20, France.,CERIMED, Aix-Marseille University, 27 Boulevard Jean-Moulin, 13385 Marseille cedex 05, France
| | - Louis Hoffart
- Ophthalmology Department, Aix-Marseille University - APHM, Hôpital de la Timone, 264 rue Saint Pierre, 13 385 Marseille Cedex 5, France.,Ramsay Générale de Santé, Clinique Monticelli-Velodrome, Marseille, France
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Wetterstrand O, Holopainen JM, Krootila K. Femtosecond Laser-Assisted Intrastromal Relaxing Incisions After Penetrating Keratoplasty: Effect of Incision Depth. J Refract Surg 2015; 31:474-9. [PMID: 26158928 DOI: 10.3928/1081597x-20150623-06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 05/20/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To correlate the efficacy of femtosecond laser-assisted intrastromal relaxing incisions after penetrating keratoplasty with the posterior depth of corneal incisions. METHODS Twenty eyes of 20 patients were treated for regular postoperative penetrating keratoplasty astigmatism. Sutures had been removed and refraction had stabilized. Ultrasound pachymetry was used to calculate incisional depth. Femtosecond laser-assisted paired arcuate incisions were made inside the graft stroma, leaving 90 µm of intact anterior cornea including epithelium. The intact posterior corneal margin was 10% of the measured corneal thickness for 10 patients (10% group) and 125 µm for the remaining 10 patients (125-µm group). Follow-up visits consisted of biomicroscopy, intraocular pressure measurement, fundus examination, and topographic evaluation using anterior segment optical coherence tomography at 1 and 3 months. Postoperative corneal thickness and the depth of incisions were measured with optical coherence tomography. RESULTS Corrected distance visual acuity improved from 0.5 to 0.3 logMAR (Snellen: 20/63 to 20/40, P < .05) in the 10% group and remained constant in the 125-µm group. The refractive cylinder decreased by 34% in the 10% group (range: 0% to 60%), but did not change in the 125-µm group. The topographic anterior cylinder decreased in both groups by 48% (range: 0% to 67%) and 13% (range: 0% to 38%), respectively. The smaller the posterior intact corneal margin, the higher the surgically induced astigmatism (P < .05). CONCLUSIONS Efficacy of femtosecond laser-assisted intrastromal relaxing incisions is correlated with the posterior depth of the incisions. The deeper incisions were more effective.
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Parker JS, van Dijk K, Melles GRJ. Treatment options for advanced keratoconus: A review. Surv Ophthalmol 2015; 60:459-80. [PMID: 26077628 DOI: 10.1016/j.survophthal.2015.02.004] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/17/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Abstract
Traditionally, the mainstay of treatment for advanced keratoconus (KC) has been either penetrating or deep anterior lamellar keratoplasty (PK or DALK, respectively). The success of both operations, however, has been somewhat tempered by potential difficulties and complications, both intraoperatively and postoperatively. These include suture and wound-healing problems, progression of disease in the recipient rim, allograft reaction, and persistent irregular astigmatism. Taken together, these have been the inspiration for an ongoing search for less troublesome therapeutic alternatives. These include ultraviolet crosslinking and intracorneal ring segments, both of which were originally constrained in their indication exclusively to eyes with mild to moderate disease. More recently, Bowman layer transplantation has been introduced for reversing corneal ectasia in eyes with advanced KC, re-enabling comfortable contact lens wear and permitting PK and DALK to be postponed or avoided entirely. We offer a summary of the current and emerging treatment options for advanced KC, aiming to provide the corneal specialist useful information in selecting the optimal therapy for individual patients.
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Affiliation(s)
- Jack S Parker
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; UAB Callahan Eye Hospital, Birmingham, Alabama, USA
| | - Korine van Dijk
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands
| | - Gerrit R J Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; Amnitrans EyeBank, Rotterdam, The Netherlands.
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Wetterstrand O, Holopainen JM, Krootila K. Treatment of Postoperative Keratoplasty Astigmatism Using Femtosecond Laser-Assisted Intrastromal Relaxing Incisions. J Refract Surg 2013; 29:378-82. [DOI: 10.3928/1081597x-20130515-01] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 03/11/2013] [Indexed: 11/20/2022]
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Corneal Graft Curvature Change After Relaxing Incisions for Post–Penetrating Keratoplasty Astigmatism. Cornea 2012; 31:1023-7. [DOI: 10.1097/ico.0b013e31823f8db9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Madi S, Santorum P, Busin M. Descemet stripping automated endothelial keratoplasty in pediatric age group. Saudi J Ophthalmol 2012; 26:309-13. [PMID: 23961011 DOI: 10.1016/j.sjopt.2012.04.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 04/28/2012] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To report the outcomes of DSAEK surgery performed in pediatric patients. DESIGN Noncomparative interventional case series. SUBJECTS AND METHODS All pediatric patients (age up to 16 years) undergoing Descemet automated stripping endothelial keratoplasty (DSAEK) at our Institution since January 2008 have been enrolled in a prospective study. A standard DSAEK, involving delivery of an 8.5-9.5 mm graft by Busin glide, was performed under general anesthesia in 19 eyes of 11 pediatric patients (congenital hereditary endothelial dystrophy n = 13; congenital glaucoma n = 2; posterior polymorphous dystrophy n = 2, and failed penetrating keratoplasty n = 2). Slit-lamp examination, refraction and visual acuity as well as endothelial cell density were evaluated preoperatively as well as 1, 3, 6, 12, and 18 months postoperatively. RESULTS All surgical procedures were uneventful. Graft detachment occurred in 4 cases and was managed successfully with repeat air injection. All corneas cleared within a week from surgery. Follow-up was 3-18 months. At last follow-up examination, best-corrected visual acuity (BCVA) was better than 20/40 in 8 of the 13 cases of patients old enough to assess vision. A graft rejection episode was seen in 1 case within 3 months from surgery but was reverted with steroidal treatment. No graft failures were observed. CONCLUSIONS DSAEK is an appropriate surgical intervention for children with corneal endothelial failure. In contrast to penetrating keratoplasty (PK), DSAEK is performed under "closed system" conditions, thus minimizing intraoperative risks. Finally, healing is much faster than with PK and all sutures can be removed within 2-4 weeks from surgery, thus allowing fast visual recovery and prompt starting of amblyopia treatment.
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Affiliation(s)
- Silvana Madi
- Department of Ophthalmology, "Villa Igea " Hospital, Forlì, Italy ; Alexandria University Eye Hospital, Alexandria, Egypt
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Current approaches for management of postpenetrating keratoplasty astigmatism. J Ophthalmol 2011; 2011:708736. [PMID: 21811668 PMCID: PMC3147001 DOI: 10.1155/2011/708736] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 06/06/2011] [Indexed: 12/02/2022] Open
Abstract
A successful corneal graft requires both clarity and an acceptable refraction. A clear corneal graft may be an optical failure if high astigmatism limits visual acuity. Intraoperative measures to reduce postkeratoplasty astigmatism include round and central trephination of cornea with an adequate size, appropriate sutures with evenly distributed tension, and perfect graft-host apposition. Suture manipulation has been described for minimising early postoperative astigmatism. If significant astigmatism remains after suture removal, which cannot be corrected by optical means, then further surgical procedures containing relaxing incisions, compression sutures, laser refractive surgery, insertion of intrastromal corneal ring segments, wedge resection, and toric intraocular lens implantation can be performed. When astigmatism cannot be reduced using one or more abovementioned approaches, repeat penetrating keratoplasty should inevitably be considered. However, none of these techniques has emerged as an ideal one, and corneal surgeons may require combining two or more approaches to exploit the maximum advantages.
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Proust H, Baeteman C, Matonti F, Conrath J, Ridings B, Hoffart L. Femtosecond laser-assisted decagonal penetrating keratoplasty. Am J Ophthalmol 2011; 151:29-34. [PMID: 21047618 DOI: 10.1016/j.ajo.2010.07.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 07/19/2010] [Accepted: 07/20/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the use of a new polygonal trephination pattern for penetrating keratoplasty (PK) assisted by femtosecond laser. DESIGN Prospective, nonrandomized clinical study. METHODS Sixteen eyes underwent decagonal PK. Nine had Fuchs dystrophy, 4 had pseudophakic bullous keratopathy, 1 had experienced trauma, 1 had corneal amyloidosis, and 1 had keratoconus. A Femtec (Tecnolas PerfectVision) laser was used to create decagonal penetrating cuts on both donor and recipient corneas. All patients were evaluated for uncorrected visual acuity, best spectacle-corrected visual acuity, pachymetry, topography, and endothelial cell density. Scanning electron microscopy was performed on corneal tissue after surgery. RESULTS All eyes were treated successfully without intraoperative complications. The mean follow-up ± standard deviation was 9.75 ± 3.5 months. Mean postoperative best spectacle-corrected visual acuity was 20/53, and there was a significant improvement in both uncorrected visual acuity (P = .0019) and best spectacle-corrected visual acuity (P = .001). At 6 months, mean ± standard deviation manifest astigmatism was 1.90 ± 1.20 diopters. Mean endothelial cell density was 1502 ± 458 cells/mm². Scanning electron microscopy displayed straight decagonal cut margins and minor remaining tissue bridges. CONCLUSIONS Use of the decagonal trephination profile was effective and safe to perform PK. Short-term visual results and refractive results are encouraging compared with those of conventional PK studies. Longer-term follow-up and comparative studies are necessary to determine precisely advantages the and optimal surgical settings of this technique.
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Feizi S, Zare M, Einollahi B. Simultaneous phacoemulsification and graft refractive surgery in penetrating keratoplasty eyes. ISRN OPHTHALMOLOGY 2011; 2011:495047. [PMID: 24527227 PMCID: PMC3912586 DOI: 10.5402/2011/495047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 07/19/2011] [Indexed: 11/23/2022]
Abstract
Purpose. To report outcomes of graft refractive surgery (GRS) along with clear-cornea phacoemulsification and intraocular lens (IOL) implantation in penetrating keratoplasty (PKP) eyes. Methods. Fourteen eyes of 13 patients who had received PKP underwent simultaneous GRS (relaxing incisions with or without counter-quadrant compression sutures) and clear-cornea phacoemulsification with IOL implantation. To calculate IOL power, preoperative keratometry readings and the SRK-T formula were used. Results. Mean patient age and follow-up period were
50.5 ± 14.4 years and 14.6 ± 7.1 months, respectively. A significant increase was observed in best spectacle-corrected visual acuity (from 0.55 ± 0.18 logMAR to 0.33 ± 0.18 logMAR, P = 0.001). There was a significant decrease in vector keratometric astigmatism by 6.22 D (P = 0.03). Spherical equivalent refraction was reduced from −3.31 ± 3.96 D to −1.69 ± 2.38 D (P = 0.02) which did not significantly differ from the target refraction (−0.76 ± 0.14 D, P = 0.20). No complications developed and all the grafts remained clear at the final examination. Conclusion. Simultaneous phacoemulsification and GRS is a safe and effective method to address post-PKP astigmatism and lens opacity. IOL power can be calculated from preoperative keratometry readings with an acceptable accuracy. However, patients should be informed about the possibility of high refractive errors postoperatively.
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Affiliation(s)
- Sepehr Feizi
- Ophthalmic Research Center, Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran 16666, Iran
| | - Mohammad Zare
- Ophthalmic Research Center, Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran 16666, Iran
| | - Bahram Einollahi
- Ophthalmic Research Center, Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran 16666, Iran
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Relaxing Incisions Combined With Adjustment Sutures for Post-Deep Anterior Lamellar Keratoplasty Astigmatism in Keratoconus. Cornea 2009; 28:1130-4. [DOI: 10.1097/ico.0b013e3181a3c400] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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[Arcuate keratotomy for postkeratoplasty astigmatism by femtosecond laser]. J Fr Ophtalmol 2009; 32:544-50. [PMID: 19616345 DOI: 10.1016/j.jfo.2009.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2009] [Accepted: 06/03/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Evaluation of the effectiveness of arcuate keratotomy performed with femtosecond laser for correction of postkeratoplasty astigmatism. METHODS This retrospective clinical study included 11 eyes. All cases underwent arcuate keratotomy using femtosecond laser. Outcome measures included visual acuity and endothelial cell density as well as refractive, keratometric, and topographic astigmatism. The incision depth was also evaluated by OCT-3. RESULTS With a mean follow-up of 7.4+/-6.7 months, uncorrected visual acuity was not modified and the mean best corrected visual acuity significantly improved from 1.68+/-1.59 lines (p=0.007). The mean preoperative refractive cylinder was 5.18+/-1.15D, decreasing to 3.41+/-1.93D (p=0.045) after laser-arcuate keratotomy. The reduction of preoperative keratometric (7.79+/-3.69D) and topographic (7.98+/-2.41D) astigmatism was higher, with a decrease to 4.81+/-2.52D (p=0.021) and 4.36+/-2.59D (p=0.005) postoperatively. Endothelial cell density was not modified after surgery. The difference between achieved and planned incision depth was -10.7+/-63.5mum. All cases were uncomplicated. DISCUSSION Arcuate keratotomies performed with the femtosecond laser were effective in reducing postkeratoplasty astigmatism and has a number of advantages over conventional techniques. However, efficacy could be improved by a more accurate nomogram. CONCLUSION Arcuate keratotomy performed with femtosecond laser is a relatively easy, safe, and effective means of treating postkeratoplasty astigmatism. Given our small sample, much larger series are needed to provide more confident estimates of astigmatism reduction proportions and to adjust correction parameters.
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Spadea L, Saviano M, Di Gregorio A, Di Lodovico D, De Sanctis F. Topographically guided two-step LASIK and standard LASIK in the correction of refractive errors after penetrating keratoplasty. Eur J Ophthalmol 2009; 19:535-43. [PMID: 19551666 DOI: 10.1177/112067210901900404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate in a long-term period the effectiveness and safety of topographically guided two-step laser in situ keratomileusis (LASIK) and standard LASIK technique in the correction of refractive errors after successful penetrating keratoplasty (PKP) for keratoconus. METHODS At least 2 years after PKP and 6 months after removal of all sutures, 15 eyes of 15 patients (Group 1; mean manifest refraction spherical equivalent (MRSE) -7.23 D -/+ 3.42 SD) were submitted to standard LASIK and 15 eyes of 15 patients (Group 2; mean MRSE -4.37 D -/+ 1.97 SD) to a topographically guided two-step LASIK procedure (first the flap and at least 2 weeks later the laser ablation). In all cases, a superior hinged corneal flap(160 microm/9.5 mm) was created. RESULTS After a follow-up of 36 months, in Group 1 the mean uncorrected visual acuity (UCVA) was 0.51 logarithm of the minimum angle of resolution (logMAR) -/+ 0.41 SD and the mean best-corrected visual acuity (BCVA) was 0.03 logMAR -/+ 0.05 SD, with a mean MRSE of -1.57 D -/+ 2.65 SD. In Group 2, the mean UCVA was 0.28 logMAR -/+ 0.24 SD and the mean BCVA was 0.01 logMAR -/+ 0.03 SD, with a mean MRSE of -0.07 D -/+ 1.00 SD. In both groups, no complications were observed. CONCLUSIONS After a long follow-up period, both topographically guided two-step LASIK and standard LASIK could be considered effective and safe tools in the correction of refractive errors after successful PKP for keratoconus.
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Affiliation(s)
- Leopoldo Spadea
- Eye Clinic, San Salvatore Hospital, University of L'Aquila, L'Aquila - Italy.
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Hoffart L, Proust H, Matonti F, Conrath J, Ridings B. Correction of postkeratoplasty astigmatism by femtosecond laser compared with mechanized astigmatic keratotomy. Am J Ophthalmol 2009; 147:779-87, 787.e1. [PMID: 19232560 DOI: 10.1016/j.ajo.2008.12.017] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Revised: 12/09/2008] [Accepted: 12/10/2008] [Indexed: 01/09/2023]
Abstract
PURPOSE To compare the effectiveness of arcuate keratotomy (AK) performed with a femtosecond laser (FSL) or Hanna keratome (Moria, Anthony, France) for correction of postkeratoplasty astigmatism. DESIGN Prospective, randomized study. METHODS This clinical study included 20 eyes. Two groups of 10 eyes underwent AK using an FLS or keratome. Refractive and keratometric astigmatism were evaluated before surgery and 6 months after surgery. The astigmatic changes in the 2 groups were measured through arithmetic and vector analysis (Alpins method). RESULTS Six months after surgery, the mean uncorrected and corrected visual acuities did not change significantly. The mean preoperative refractive cylinder was 8.6 +/- 3.0 diopters (D) and 6.7 +/- 2.1 D, decreasing to 3.9 +/- 2.4 D and 4.7 +/- 2.4 D after laser AK and mechanized AK, respectively. The mean arithmetic change was significantly higher after laser AK, with a decrease of -55.4 +/- 20.7% (P = .011). Vector analysis showed a systematic undercorrection of astigmatism in both groups with a refractive correction index of 0.82 and 0.90 after laser AK and mechanized AK, respectively. Although no statistically significant differences were detected, a wider spread of angle of error and an almost significant difference of mean absolute angle of error (P = .052) suggest a larger misalignment of treatment during mechanized AK. All cases were uncomplicated after laser AK, 1 microperforation occurred and 1 case with off-center incisions occurred after mechanized AK. CONCLUSIONS AK performed with the femtosecond laser was effective in reducing postkeratoplasty astigmatism and has some advantages over conventional techniques. However, efficacy could be improved by a more accurate nomogram and alignment of treatment.
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Outcomes of Augmented Relaxing Incisions for Postpenetrating Keratoplasty Astigmatism in Keratoconus. Cornea 2009; 28:280-4. [DOI: 10.1097/ico.0b013e3181875496] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Claesson M, Armitage WJ. Astigmatism and the Impact of Relaxing Incisions After Penetrating Keratoplasty. J Refract Surg 2007; 23:284-9. [PMID: 17385295 DOI: 10.3928/1081-597x-20070301-12] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the impact of relaxing incisions for correcting postoperative astigmatism following penetrating keratoplasty. METHODS Data were collected through the Swedish Corneal Transplant Register. Of the 1161 grafts with complete 2-year follow-up, 131 underwent relaxing incisions. Stepwise multiple regression was used to determine the factors that influenced the extent of astigmatism in diopters (D) (square root transformed). The change in astigmatism brought about by relaxing incisions was evaluated both by subtraction (ie, ignoring angle) and vector analysis. RESULTS The overall mean astigmatism was 4.56 D (95% confidence interval [CI]: 4.40-4.73, n = 1161). The final regression model explained only a small proportion of the overall variability of the data (< 5%). There was a slight increase in postoperative astigmatism with recipient age (P = .025), and two of the seven participating clinics achieved lower levels of astigmatism (P = .001 and P = .036, respectively). In patients who underwent relaxing incisions, astigmatism was reduced from 8.40 D (95% CI: 8.0-9.0, n = 131) to 3.80 D (95% CI: 3.5-4.3). The mean difference by subtraction was 4.50 D (95% CI: 4.0-5.0, P < .001, paired t test). Vector analysis showed the overall reduction of astigmatism due to surgery to be 7.90 D (95% CI: 7.2-8.7). Compared with grafts with no refractive surgery, a trend was noted that suggested corrected visual acuity was improved following relaxing incisions. CONCLUSIONS Relaxing incisions were found to be a safe and effective method for reducing postoperative astigmatism and may improve visual acuity.
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Affiliation(s)
- Margareta Claesson
- Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden.
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22
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Spadea L, Mosca L. Topographically guided LASIK. Ophthalmology 2006; 113:1251.e1-2. [PMID: 16815418 DOI: 10.1016/j.ophtha.2006.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 03/13/2006] [Indexed: 11/20/2022] Open
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Abstract
PURPOSE To determine if using corneal topography for planning arcuate relaxing incision placement for postkeratoplasty astigmatism improves clinical results. METHODS Twenty-six eyes with high levels (> 5 diopters [D]) of postkeratoplasty astigmatism were studied in a nonrandomized, retrospective, observational case series. Relaxing incisions were placed in the peripheral graft in each steep topographic hemimeridian. The following data were measured: keratometric, topographic, and refractive vector analysis; nonvector astigmatism reduction; surface regularity and asymmetry (surface regularity index and surface asymmetry index); topography patterns; surgical design; and visual acuity. RESULTS Topographic analysis changed some aspect of the surgery in 51/52 incisions with a 15.7 degrees mean change in incision location. The mean vector correction index (CI) was 0.89 to 0.92 for keratometric, topographic, and refractive indices. Sixty-five percent of eyes had surgically induced astigmatism (SIA) values within 2 D of the surgical goal. Eighty-one percent of eyes had at least a 50% reduction in net astigmatism and 85% had < or = 3-D residual refractive cylinder. The mean logMAR visual acuity increased 2 lines. The preoperative and postoperative spherical equivalent showed a high correlation (rho = 0.914, P = 0.000). The correlation between SIA and targeted induced astigmatism (TIA) was 0.56 (P = 0.003). There was a significant improvement in surface regularity index (P = 0.000) and surface asymmetry index (P = 0.05) values. No statistically significant correlations were found between total incision length and SIA or TIA, or between TIA and correction index. All patients had symmetric (58%) or asymmetric (42%) bowtie topographic patterns preoperatively with 35% achieving round/oval patterns postoperatively. CONCLUSIONS Topography-guided relaxing incision offers an easy method to plan surgery and has some limited advantages over conventional techniques.
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Affiliation(s)
- Harry S Geggel
- Section of Ophthalmology, Virginia Mason Medical Center, Seattle, WA 98101, USA.
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Javadi MA, Motlagh BF, Jafarinasab MR, Rabbanikhah Z, Anissian A, Souri H, Yazdani S. Outcomes of penetrating keratoplasty in keratoconus. Cornea 2006; 24:941-6. [PMID: 16227837 DOI: 10.1097/01.ico.0000159730.45177.cd] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Keratoconus (KCN) is one of the most common indications of corneal transplantation in Iran. This study was conducted to determine the outcomes of penetrating keratoplasty (PK) for KCN in patients operated in a private practice setting from 1994 to 2001. METHODS This longitudinal retrospective study included 164 eyes of 164 patients. Variables included preoperative keratometry, trephination and suturing techniques, donor-recipient disparity, surgical complications, immunologic rejection, graft clarity, postoperative spherical and cylindrical refractive error, keratometry, uncorrected and best spectacle-corrected visual acuity, suture management, and the results of keratorefractive procedures. RESULTS Patients were followed for a mean period of 33.5 months. Mean postoperative best spectacle-corrected visual acuity (BSCVA) at last follow-up was 0.14 +/- 0.11 LogMAR (20/25); mean spherical error and mean corneal astigmatism were -0.61 +/- 2.6 and 3.4 +/- 1.8 D, respectively. Final visual outcomes were not significantly correlated with trephination and suturing techniques or severity of the ectasia. Although donor-recipient disparity did not affect final astigmatism, more myopic shift was observed with greater disparity, but this finding was not of statistical significance. Overall, 26.8% of the patients required keratorefractive surgery, which resulted in 2.9 D reduction in corneal astigmatism. Immunologic graft rejection occurred in 28% of cases; however, all episodes responded to medical management, and none resulted in graft failure. CONCLUSION Penetrating keratoplasty is a safe and effective procedure with remarkable optical and visual outcomes for patients with keratoconus who are contact lens intolerant or have unacceptable corrected visual acuity. Neither severity of the disorder nor trephination and suturing techniques significantly affects final visual outcomes. Less graft-recipient disparity (0.25 versus 0.50 mm) seems to induce less myopic shift.
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Affiliation(s)
- Mohammad Ali Javadi
- Department of Ophthalmology, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
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25
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Mularoni A, Laffi GL, Bassein L, Tassinari G. Two-step LASIK With Topography-guided Ablation to Correct Astigmatism After Penetrating Keratoplasty. J Refract Surg 2006; 22:67-74. [PMID: 16447939 DOI: 10.3928/1081-597x-20060101-14] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the efficacy, predictability, stability, and safety of a two-step LASIK procedure using topography-guided ablation to correct astigmatism after penetrating keratoplasty. METHODS Fifteen eyes of 15 patients underwent a two-step LASIK procedure at the Maggiore Hospital of Bologna, Italy. In the first step, a flap was created using the Hansatome microkeratome. In the second step, topography-guided ablation using the LaserSight LSX was planned with interactive software (CIPTA) once topographical and refractive stabilization had been obtained. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), cylindrical correction, gain of lines of BSCVA, spherical equivalent refraction, and complications were analyzed. RESULTS Minimum follow-up was 12 months (range: 12 to 30 months). Uncorrected visual acuity improved in all 15 (100%) eyes. At the last postoperative examination, 11 (73%) eyes had UCVA > or = 20/40. Nine (60%) eyes were within 1.0 diopter (D) of the attempted correction. Mean postoperative astigmatism was -1.67 (range: -3.5 to 0; standard deviation: 1.26). Index of success of astigmatic correction was 0.26. No patient lost Snellen lines of BSCVA. Intraoperative complications included two buttonhole flaps, and postoperative complications included one flap retraction. No further laser treatment was needed. CONCLUSIONS The two-step LASIK procedure using topography-guided ablation reduces spherical and cylindrical refractive error due to penetrating keratoplasty. Topography-guided ablation also proved to be effective in correcting irregular astigmatism.
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Solomon R, Donnenfeld ED, Perry HD, Nirankari VS. Post-LASIK corneal flap displacement following penetrating keratoplasty for bullous keratopathy. Cornea 2005; 24:874-8. [PMID: 16160509 DOI: 10.1097/01.ico.0000154412.45433.6f] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report 3 patients who experienced late flap dislocation after laser in situ keratomileusis (LASIK) in eyes that had undergone prior penetrating keratoplasty (PKP) for bullous keratopathy. METHODS Retrospective chart review of 2 referral corneal and refractive surgery practices, case reports, and literature review. RESULTS Three patients (mean age 58.3 years, 2 male, 1 female), all status post-corneal transplant for bullous keratopathy, had residual myopic astigmatism and underwent LASIK for correction of their significant anisometropia. Flap dislocation occurred at a mean of 7 days (range 3 to 14 days) following the LASIK procedure. All patients had peripheral corneal edema in their recipient bed. All 3 patients required an additional surgical procedure for visual rehabilitation. CONCLUSION Flap displacement may occur following LASIK in patients who have undergone PKP for bullous keratopathy. The endothelial pump function, which is vital to maintaining flap adherence, may be compromised in these patients. We suggest that patients with a history of PKP and endothelial compromise who undergo LASIK wear protective shields for a longer than normal period and be followed closely to reduce the risk of flap slippage.
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Affiliation(s)
- Renée Solomon
- Ophthalmic Consultants of Long Island, Rockville Centre, New York, NY 11570, USA
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27
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Walker NJ, Apel AJG. Effect of hinged lamellar keratotomy on post-keratoplasty astigmatism and vision. Clin Exp Ophthalmol 2004; 32:147-53. [PMID: 15068430 DOI: 10.1111/j.1442-9071.2004.00800.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To show that hinged lamellar keratotomy alone affects refraction and vision in post-keratoplasty eyes. METHODS A retrospective, non-comparative, interventional case series was conducted on 28 eyes of 26 patients who had two-stage laser in situ keratomileusis (LASIK) after penetrating keratoplasty. Records were reviewed with respect to the hinged lamellar keratotomy component of the procedure. The interval between keratoplasty and keratotomy was at least 1 year, and the follow-up period averaged 29 +/- 10 days. The Automated Corneal Shaper with nasal hinge was used. In addition to basic empirical astigmatism calculations, the Alpins method of astigmatism analysis was also employed to ensure that the influence of changes in cylinder axis were correctly taken into account when calculating the refractive change. RESULTS Surgically induced astigmatism from hinged lamellar keratotomy was not statistically significant in this series; however, the range in values (-9.06 to +7.57 D) has potential clinical ramifications. Nearly 70% of cases studied experienced surgically induced astigmatism of at least 2 D. Mean preoperative uncorrected vision was logMAR 1.06 +/- 0.41, which improved marginally postoperatively to logMAR 1.03 +/- 0.44 (P = 0.36). Best spectacle-corrected visual acuity averaged logMAR 0.21 +/- 0.16 preoperatively, improving to logMAR 0.09 +/- 0.15 (range -0.18 to 0.42) postoperatively, which was a statistically significant improvement (P < 0.01). No difference in refractive or visual outcomes was identified when those with keratoconus were compared to those with other underlying corneal disease processes. CONCLUSION Although mean surgically induced astigmatism was not statistically significant, hinged lamellar keratotomy caused considerable changes in astigmatism in nearly 70% of post-keratoplasty eyes studied. This suggests that clinically significant inaccuracies may result if a one-stage LASIK procedure is performed on such patients. The authors suggest that reassessment of refraction after keratotomy may improve refractive outcomes.
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Affiliation(s)
- Nathan J Walker
- Ophthalmology Department, Cairns Base Hospital, Cairns, Queensland, Australia.
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Lim L, Pesudovs K, Goggin M, Coster DJ. Late onset post-keratoplasty astigmatism in patients with keratoconus. Br J Ophthalmol 2004; 88:371-6. [PMID: 14977772 PMCID: PMC1772053 DOI: 10.1136/bjo.2003.027037] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM 10 eyes of 10 patients are reported where progression of keratoconus in the host cornea occurred more than 10 years after penetrating keratoplasty with resultant increase in astigmatism. The technique and results of graft refractive surgery in seven eyes are presented. METHODS The clinical features and management of these patients were retrospectively analysed. Graft refractive surgery involved an incision at the graft-host junction adjacent to the host thinning with compressive resuturing. Astigmatic changes were calculated using vector analysis. RESULTS There were seven men and three women with a mean age of 41.2 years. The average age when undergoing penetrating keratoplasty in the affected eye was 28.4 years and the average time after penetrating keratoplasty until keratoconus appeared in the host cornea defined by host thinning was 13.5 years. The mean cylinder power before host thinning was noted was 5.07 D (SD 2.19) and the mean after host thinning was 11.0 D (2.53). The mean vector calculated disease induced astigmatism magnitude was 7.59 D (3.09). Graft refractive surgery was performed in seven eyes. The mean cylinder power before and after graft refractive surgery was 11.28 D (2.15) and 7.09 D (5.53) respectively. The surgically induced astigmatism vector magnitude was 7.36 D (4.88). CONCLUSION Progression of keratoconus in the host cornea late after penetrating keratoplasty is characterised by a large astigmatic change where the flat axis of astigmatism passes through an area of host thinning visible on slit lamp examination. Compressive resuturing performed in the area of host thinning resulted in satisfactory reduction of astigmatism.
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Affiliation(s)
- L Lim
- Department of Ophthalmology, Flinders Medical Centre, Flinders University of South Australia, Bedford Park 5042, South Australia
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Bourges JL, Savoldelli M, Dighiero P, Assouline M, Pouliquen Y, BenEzra D, Renard G, Behar-Cohen F. Recurrence of keratoconus characteristics: a clinical and histologic follow-up analysis of donor grafts. Ophthalmology 2003; 110:1920-5. [PMID: 14522765 DOI: 10.1016/s0161-6420(03)00617-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To report on clinical corneal topography, histopathologic analysis, and fine structure findings in failed grafts after penetrating keratoplasty (PK) for keratoconus (KC). DESIGN Retrospective, consecutive, interventional case series with histologic and clinical correlation. PARTICIPANTS Twelve corneal buttons were obtained from consecutive patients undergoing repeated PK 10 to 28 years after the initial PK for KC. The indication for regrafting was endothelial deficiency in seven cases, irreversible immune graft rejection in two cases, and corneal ectasia in three cases. METHODS Removed corneal buttons were examined by light and transmission electron microscopy. A potential correlation between the clinical and videokeratoscopic findings and the microscopic structural observations was analyzed. RESULTS Preoperative simulated keratometry measured by TMS-1 (Tomey, New York, NY) or EyeSys CAS (EyeSys Technology, Houston, TX) ranged from 49.8 to 66.1 diopters. A pattern compatible with KC characteristics was observed in all cases. Fine structure analysis revealed Bowman's layer disruption or folds and stromal deposits in all corneal buttons. However, central corneal thinning was not present in any of the removed buttons. CONCLUSIONS Structure changes compatible with the diagnosis of KC were observed in all donor buttons many years after PK on KC recipients. Recurrence of the KC characteristics may result from graft repopulation by recipients' keratocytes, aging of the grafted tissue, or both.
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Vajpayee RB, Sharma N, Sinha R, Bhartiya P, Titiyal JS, Tandon R. Laser in-situ keratomileusis after penetrating keratoplasty. Surv Ophthalmol 2003; 48:503-14. [PMID: 14499818 DOI: 10.1016/s0039-6257(03)00085-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Laser in situ keratomileusis (LASIK) after penetrating keratoplasty has been used more commonly for the correction of myopia or myopic astigmatism and less so for hypermetropia or hyperopic astigmatism. The primary goal after LASIK in such cases is resolution of sufficient myopia and astigmatism to allow spectacle correction of the residual refractive error and decrease anisometropia. All sutures should be removed prior to LASIK and the interval between penetrating keratoplasty and LASIK should be a minimum of 1 year. Preoperative evaluation includes refraction, slit-lamp biomicroscopy, corneal topography, and specular microscopy. The technique of LASIK surgery after penetrating keratoplasty is similar to the standard procedure. However, many variations have been described. These include maneuvers during surgery such as augmentation with arcuate cuts on the stromal bed and topographically guided LASIK. Other variations are relaxing incisions followed by LASIK surgery and sequential treatment by LASIK, that is, raising of the flap as a first stage procedure followed by ablation if required, 4 to 6 weeks later after relifting the flap in the second stage. Improvement in both uncorrected visual acuity and spectacle-corrected visual acuity, as well as a decrease in spherical equivalent, cylinder, and anisometropia, has been reported in various studies. All grafts were clear and no occurrence of wound dehiscence has been reported. Intraoperative complications include hemorrhage, microkeratome failure, flap buttonhole, dislocation, and perforation. Postoperative complications include undercorrection, decentered ablation, and regression. Re-enhancements after LASIK following keratoplasty are possible with acceptable visual outcome.
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Affiliation(s)
- Rasik B Vajpayee
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Busin M, Zambianchi L, Garzione F, Maucione V, Rossi S. Two-stage Laser in situ Keratomileusis to Correct Refractive Errors After Penetrating Keratoplasty. J Refract Surg 2003; 19:301-8. [PMID: 12777025 DOI: 10.3928/1081-597x-20030501-06] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the effect of a two-stage laser in situ keratomileusis (LASIK) procedure on eyes with high astigmatism and/or anisometropia after penetrating keratoplasty. METHODS Eleven postoperative penetrating keratoplasty eyes were included in a prospective, non-controlled study. All patients had at least 4.00 D of astigmatism and/or at least 3.00 D of anisometropia and were spectacle and contact lens intolerant. Two-stage LASIK was performed; in the first stage a hinged corneal flap 160 microm in thickness and 9 mm in diameter was created. After stabilization of corneal shape (1 to 3 months after keratotomy), the corneal flap was lifted and laser refractive treatment (second stage) was performed. RESULTS After the first stage, a statistically significant reduction in refractive astigmatism (P<.01) was recorded. In all eyes but one, best spectacle-corrected visual acuity was maintained or improved after the procedure. Three months after the second stage, refractive astigmatism in 8 of 11 eyes (73%) was within +/- 1.00 D, and spherical equivalent refraction in 9 of 11 eyes (82%) was within +/- 1.00 D of intended correction. Preoperative irregular astigmatism persisted in three patients (3 eyes) who could not be corrected within +/- 1.00 D of refractive astigmatism and/or +/- 1.00 D of intended spherical equivalent refraction. In one eye, an interface infiltrate developed shortly after creation of the flap, and resulted in limited melting. CONCLUSIONS A two-stage LASIK procedure improved visual acuity and refraction in postoperative penetrating keratoplasty eyes with high astigmatism and/or anisometropia. Complications were uncommon but can lead to loss of vision.
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Affiliation(s)
- Massimo Busin
- Villa Serena Hospital, Department of Ophthalmology, Forli, Italy.
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Lee GA, Pérez-Santonja JJ, Maloof A, Ficker LA, Dart JKG. Effects of lamellar keratotomy on postkeratoplasty astigmatism. Br J Ophthalmol 2003; 87:432-5. [PMID: 12642305 PMCID: PMC1771601 DOI: 10.1136/bjo.87.4.432] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To determine the changes in postkeratoplasty astigmatism induced by lamellar keratotomy. METHODS A prospective, non-randomised comparative trial of patients undergoing a hinged lamellar corneal flap for treatment of significant astigmatism after penetrating keratoplasty. Uncorrected visual acuity, best corrected visual acuity, refraction, and corneal topography were assessed at 1 and 3 months after the lamellar keratotomy. RESULTS 17 eyes in 16 patients (13 M, 3F) were included in the study (mean age 48.2 years; range 20-86 years). Six of 17 eyes (35.3%) changed more than 1 dioptre (D) in spherical equivalent by 3 months. Nine of 17 eyes (52.9%) changed more than 1 D in sphere by 3 months. 12 of 17 eyes (70.6%) changed more than 1 D in refractive cylinder. Seven patients of 15 (46.7%) changed more than 1 D in corneal power as measured topographically. Five of 17 eyes (29.4%) changed in refractive cylinder axis more than 15 degrees and this was similar to the change measured topographically of four of 15 eyes (26.7%). Vector analysis showed 60% of eyes had a surgically induced astigmatism (SIA) vector of more than 1 D, including a net corneal astigmatism decrease of more than 1 D in four eyes and increase of more than 1 D in two eyes at 3 months after surgery. Complications of the lamellar keratotomy included two partial buttonholes and one partial wound dehiscence. CONCLUSIONS The creation of a lamellar flap alone can have significant effects on the astigmatism following penetrating keratoplasty. LASIK for correction of postkeratoplasty astigmatism may be more accurately performed as a two stage procedure rather than a single stage, after the corneal effects of the lamellar keratotomy have stabilised.
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Affiliation(s)
- G A Lee
- Cornea and External Disease Service, Moorfields Eye Hospital, London, UK.
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33
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Donnenfeld ED, Solomon R, Biser S. Laser in situ keratomileusis after penetrating keratoplasty. Int Ophthalmol Clin 2002; 42:67-87. [PMID: 12409923 DOI: 10.1097/00004397-200210000-00008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Eric D Donnenfeld
- Ophthalmic Consultants of Long Island, Rockville, Centre, NY 11570, USA
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34
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Sen HN, Uusitalo R, Laatikainen L. Subclinical inflammation after laser in situ keratomileusis in corneal grafts. J Cataract Refract Surg 2002; 28:782-7. [PMID: 11978455 DOI: 10.1016/s0886-3350(02)01239-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate postoperative inflammatory reaction in the eye after laser in situ keratomileusis (LASIK) in corneal grafts. SETTING Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland. METHODS Ten eyes of 9 patients with penetrating keratoplasty (PKP) and significant postoperative refractive errors and astigmatism had LASIK 22 months or more after the PKP. All patients were treated with the VISX Star excimer laser and the Bausch & Lomb Hansatome microkeratome. Preoperative and early postoperative inflammation was evaluated by quantifying the aqueous flare intensity with a laser flare photometer (Kowa FM-500). A full ophthalmic assessment was also performed before LASIK and up to 6 months postoperatively. RESULTS The inflammatory response was mild and limited to the first postoperative hour. The mean anterior chamber flare increased from 6.0 photons/millisecond (ph/ms) preoperatively to 14.0 ph/ms at 1 hour and then decreased to 6.7 ph/ms (hour 3), 6.8 ph/ms (day 1), and 8.2 ph/ms (day 7). The mean spherical equivalent (SE) refraction decreased from -3.81 diopters (D) (range -9.63 to -0.25 D) to -0.46 D (range -1.13 to +0.38 D), and the mean preoperative astigmatism decreased from 3.0 D (range 6.5 to 0.5 D) to 0.7 D (range 0.0 to 2.0 D). At the last examination, 9 eyes were within +/-1.0 D (6 within +/-0.5 D) and all were within +/-1.5 D of the intended SE refraction. Three eyes achieved full cylinder correction, and 7 were within +/-1.0 D of the intended correction. Eight eyes had a best corrected visual acuity of 20/40 or better (unchanged or gain of 1 to 4 lines [6], loss of 1 line [1], and loss of 3 lines [1]), and 8 had an uncorrected visual acuity of 20/50 or better. CONCLUSIONS Uneventful LASIK induced subtle, short-lasting anterior chamber flare when measured by the laser flare meter. In corneal grafts, LASIK appeared to be a safe and effective procedure for residual refractive errors.
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Affiliation(s)
- Hatice Nida Sen
- Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland.
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Busin M, Arffa RC, Zambianchi L, Lamberti G, Sebastiani A. Effect of hinged lamellar keratotomy on postkeratoplasty eyes. Ophthalmology 2001; 108:1845-51; discussion 1851-2. [PMID: 11581060 DOI: 10.1016/s0161-6420(01)00702-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the effect of a hinged lamellar keratotomy on refraction, vision, and corneal topography of postkeratoplasty eyes with high-degree astigmatism. DESIGN Noncomparative, interventional case series. PARTICIPANTS A hinged lamellar keratotomy was performed on nine eyes of nine patients at least 9 months after penetrating keratoplasty and with high-degree astigmatism. All patients were spectacle and contact lens intolerant. INTERVENTION A superiorly hinged lamellar keratotomy (corneal flap), 160 microm in thickness and 9 mm in diameter, was created on all eyes included in this study. Each patient was examined 1 day, 1 month, and 3 months after surgery. MAIN OUTCOME MEASURES Uncorrected visual acuity, best spectacle-corrected visual acuity, refraction, computerized analysis of corneal topography. RESULTS At each postoperative examination time, there was a significant reduction in both average spherical equivalent (P < 0.05) and average absolute value of astigmatism (P < 0.01) over mean preoperative values. The major changes were seen as early as 1 day after surgery, but both progression and regression of the effect were documented at later postoperative examinations. In all patients best spectacle-corrected acuity was maintained or improved after the procedure. Postoperatively, four patients could be successfully corrected either with spectacles (n = 2) or with gas-permeable contact lenses (n = 2). There were no surgical flap or corneal graft complications. CONCLUSIONS Hinged lamellar keratotomy improves vision and refraction of postkeratoplasty eyes with high-degree astigmatism. In some cases it may be so effective as to make planned excimer laser treatment unnecessary.
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Affiliation(s)
- M Busin
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Lim L, Pesudovs K, Coster DJ. Penetrating keratoplasty for keratoconus: visual outcome and success. Ophthalmology 2000; 107:1125-31. [PMID: 10857832 DOI: 10.1016/s0161-6420(00)00112-3] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
OBJECTIVE To determine the long-term effect on vision of penetrating keratoplasty performed for keratoconus. DESIGN Retrospective noncomparative case series. PARTICIPANTS All patients with keratoconus who received a corneal graft and who remained in our center for follow-up and visual rehabilitation during the study period. INTERVENTION Penetrating keratoplasty was performed in 93 eyes of 78 patients. MAIN OUTCOME MEASURES Graft survival, visual acuity, and astigmatism. RESULTS One (1.08%) graft failure was encountered over a mean follow-up of 46 months. Mean preoperative (best corrected) and postoperative visual acuity is (best-tolerated correction) were 0.9 (20/160) and 0.24 (20/80) logMAR, respectively. Visual acuity in 86% of eyes was 0.3 logMAR (20/40) or better at the latest follow-up, with 67% of eyes being corrected with spectacles. Mean preoperative corneal power by keratometry was more than 52 diopters (D) in 83% of eyes; mean postoperative corneal power was 45 +/- 2 D. No significant predictors of postgraft astigmatism were found. Mean preoperative and postoperative best-eye acuities of the better eye were 0.32 (20/40-1) and 0.18 (20/32+1) logMAR, respectively (P < 0.001). CONCLUSIONS Graft survival was excellent. A corrected visual acuity of 20/40 or better was obtained in 86% of eyes. Astigmatism could not be predicted from preoperative factors. Visual acuity measured in the better eye improved by 0.14 logMAR (1.4 lines), implying an overall functional gain for the patient.
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Affiliation(s)
- L Lim
- Department of Ophthalmology, Flinders Medical Centre, Flinders University of South Australia, Bedford Park
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Koay PY, McGhee CN, Weed KH, Craig JP. Laser in situ Keratomileusis for Ametropia After Penetrating Keratoplasty. J Refract Surg 2000; 16:140-7. [PMID: 10766382 DOI: 10.3928/1081-597x-20000301-06] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the efficacy of excimer laser in situ keratomileusis (LASIK) in the treatment of refractive errors after penetrating keratoplasty. METHODS Eight eyes underwent LASIK after a mean 71 months (SD 60) following the initial penetrating keratoplasty. A full ophthalmic assessment was performed before LASIK and at 1 week, 1, 3, 6, and 12 months after surgery. Mean follow-up was 8.6 months (SD 3.2). RESULTS No eyes lost any Snellen lines of best spectacle-corrected visual acuity at the latest follow-up. Mean reduction in spherical equivalent refraction was 91% from -6.79 D (SD 4.17) to -0.64 D (SD 1.92) and mean reduction of cylinder was 72% from -6.79 D (SD 3.28) to -1.93 D (SD 1.17) at 6 months. Mean surgically induced astigmatism was 5.50 D (SD 2.42) and the index of surgically induced astigmatism divided by the initial cylinder expressed as a percentage was 81%. Mean outcome indices were: correction index 0.87, index of success 0.31, and angle of error 0.95 degrees. Three eyes (43%) achieved a spherical equivalent refraction of +/-0.50 D and 4 eyes (57%) achieved a spherical equivalent refraction of +/-1.00 D of emmetropia. CONCLUSIONS The efficacy of LASIK after penetrating keratoplasty was good compared to incisional or surface based excimer laser methods and has the advantage of reducing the myopic spherical equivalent refraction in addition to astigmatism, thus improving the uncorrected visual acuities.
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Affiliation(s)
- P Y Koay
- Corneal Diseases and Excimer Laser Research Unit, University of Dundee, Scotland, United Kingdom.
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Spadea L, Mosca L, Balestrazzi E. Effectiveness of LASIK to Correct Refractive Error After Penetrating Keratoplasty. Ophthalmic Surg Lasers Imaging Retina 2000. [DOI: 10.3928/1542-8877-20000301-07] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Donnenfeld ED, Kornstein HS, Amin A, Speaker MD, Seedor JA, Sforza PD, Landrio LM, Perry HD. Laser in situ keratomileusis for correction of myopia and astigmatism after penetrating keratoplasty. Ophthalmology 1999; 106:1966-74; discussion 1974-5. [PMID: 10519594 DOI: 10.1016/s0161-6420(99)90410-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To determine the safety and effectiveness of laser in situ keratomileusis (LASIK) for visual rehabilitation of residual myopia and astigmatism after penetrating keratoplasty. DESIGN Prospective, noncomparative case series. PARTICIPANTS LASIK was performed on 23 eyes of 22 patients unable to wear glasses or contact lenses after penetrating keratoplasty due to anisometropia, high astigmatism, and/or contact lens-intolerance. METHODS All patients underwent LASIK for visual rehabilitation after penetrating keratoplasty. Uncorrected visual acuity and best spectacle-corrected visual acuity, degree of anisometropia, and corneal transplant integrity were recorded before surgery, as well as at 1 month, 3 months, 6 months, and 12 months after LASIK surgery. RESULTS The mean spherical equivalent before surgery was -7.58+/-4.42 diopters (D), which was reduced to -1.09+/-2.01 D, -0.79+/-1.84 D, -0.77+/-1.25 D, and -1.57+/-1.20 D, respectively, at 1, 3, 6, and 12 months after LASIK. The mean cylinder before surgery was 3.64+/-1.72 D, which was reduced to 1.98+/-1.15 D, 1.64+/-1.14 D, 1.48+/-0.92 D, and 1.29+/-1.04 D, respectively, at 1, 3, 6, and 12 months after LASIK. Spherical equivalent anisometropia was reduced from a mean of 6.88+/-4.4 D to 1.42+/-1.05 D at the final examination. Best-corrected visual acuity remained the same or improved in 21 of 23 eyes and decreased by 1 and 3 lines in 2 patients. There were no surgical flap or corneal transplant complications. CONCLUSIONS LASIK is a viable treatment alternative for myopia and astigmatism after penetrating keratoplasty in patients who are contact lens-intolerant. LASIK is more effective in treating myopia than astigmatism after penetrating keratoplasty.
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Affiliation(s)
- E D Donnenfeld
- Department of Ophthalmology, North Shore University Hospital, Manhasset, New York 11530, USA
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Güell JL, Gris O, de Muller A, Corcostegui B. LASIK for the Correction of Residual Refractive Errors From Previous Surgical Procedures. Ophthalmic Surg Lasers Imaging Retina 1999. [DOI: 10.3928/1542-8877-19990501-04] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Borderie VM, Touzeau O, Chastang PJ, Laroche L. Surgical correction of postkeratoplasty astigmatism with the Hanna arcitome. J Cataract Refract Surg 1999; 25:205-11. [PMID: 9951665 DOI: 10.1016/s0886-3350(99)80127-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the results of arcuate keratotomy performed with the Hanna arcitome in patients with postkeratoplasty astigmatism. SETTING Department of Ophthalmology, Saint-Antoine Hospital, Paris VI University, Paris, France. METHODS This retrospective study comprised 22 eyes (22 patients) with postkeratoplasty astigmatism. Paired symmetrical arcuate keratotomy was performed with the Hanna arcitome. Outcome measures included refraction, videokeratography, and keratometry. RESULTS At 6.6 months +/- 8.9 (SD) after surgery, the mean increase in best spectacle-corrected visual acuity (BSCVA) was 2.1 +/- 2.4 lines. Thirteen eyes gained 2 lines or more of BSCVA, and 15 gained 3 lines or more of uncorrected visual acuity. Two patients had a decrease in BSCVA: 1 had lens opacification unrelated to arcuate keratotomy and 1, increased corneal irregularity. Mean refractive astigmatism was 6.94 +/- 2.11 diopters (D) preoperatively and 3.85 +/- 1.95 D postoperatively (P < .01). Mean change in keratometric astigmatism was -51 +/- 36%. Astigmatism decreased in 21 eyes as measured by manifest refraction, keratometry, and videokeratography; it increased in 1 cornea with a microperforation. CONCLUSIONS The results of arcuate keratotomy performed with the Hanna arcitome were comparable to those with freehand relaxing incisions. The instrument made safer and more uniform arcuate incisions than a freehand technique.
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Affiliation(s)
- V M Borderie
- Department of Ophthalmology, Hôpital Saint Antoine, Paris, France
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Karabatsas CH, Cook SD, Figueiredo FC, Diamond JP, Easty DL. Combined interrupted and continuous versus single continuous adjustable suturing in penetrating keratoplasty: a prospective, randomized study of induced astigmatism during the first postoperative year. Ophthalmology 1998; 105:1991-8. [PMID: 9818595 DOI: 10.1016/s0161-6420(98)91114-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To compare postoperative astigmatism induced by two different suturing techniques in penetrating keratoplasty (PKP). DESIGN A monocenter, prospective, randomized clinical trial with a longitudinal 1-year follow-up. PARTICIPANTS A total of 95 eyes undergoing PKP were randomized into 2 groups. Of these, 51 eyes were allocated to the combined interrupted and continuous suturing group (ICS) and 44 eyes to the single continuous adjustable suturing (SCAS) group. INTERVENTION In the ICS group, suturing was with a combination of 12 interrupted 10-0 nylon and 1 continuous 11-0 nylon sutures. Eyes in the SCAS group had been sutured with a single running 24-bite 10-0 nylon. Selective suture removal started no earlier than 10 weeks after surgery; suture adjustment could start as soon as possible after surgery. MAIN OUTCOME MEASURES Astigmatism was measured by topography, keratometry, and refraction at 3-, 6-, 9-, and 12-month postoperative intervals. RESULTS The difference in mean time of suture manipulation between groups was significant (P = 0.0001), with the SCAS starting earlier. A significant decrease in astigmatism occurred by either interrupted suture removal (6.69 +/- 3.11 diopter [D] before to 4.76 +/- 2.99 D after, P = 0.0002) or suture adjustment (7.18 +/- 3.12 D before to 4.46 +/- 3.24 D after, P = 0.0001). However, the net astigmatic reduction in the SCAS group was not significantly greater (P = 0.250) than in the ICS group. Vector change was 7.40 +/- 4.17 D and 6.28 +/- 4.14 D for SCAS and ICS, respectively (P = 0.13). At no interval (3, 6, 9, or 12 months) was there significant difference in astigmatism between the two groups. Refractive astigmatism (cyl, D) at 1 year was 2.66 +/- 1.70 for the ICS and 3.12 +/- 2.62 for the SCAS, but there was no significant treatment effect (P = 0.945). Furthermore, 66% of the ICS eyes and 58% of the SCAS eyes (P = 0.295) were within the astigmatic target of the study (<3.5 D). CONCLUSIONS Postkeratoplasty astigmatism can be decreased similarly with either adjustment of a single running suture or selective removal of interrupted sutures. No advantage of the SCAS over ICS in terms of fewer manipulations or less astigmatism was seen as suggested previously.
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Affiliation(s)
- C H Karabatsas
- Department of Ophthalmology, Bristol Eye Hospital, England
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Busin M, Zambianchi L, Franceschelli F, Lamberti G, al-Naweiseh I. Intraoperative cauterization of the cornea can reduce postkeratoplasty refractive error in patients with keratoconus. Ophthalmology 1998; 105:1524-9; discussion 1529-30. [PMID: 9709768 DOI: 10.1016/s0161-6420(98)98040-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the effect of intraoperative corneal cauterization on the postkeratoplasty refraction of patients with keratoconus. DESIGN A randomized clinical trial. PARTICIPANTS Thirty eyes of 29 patients with keratoconus undergoing standard penetrating keratoplasty by the same surgeon were evaluated (MB). INTERVENTION Standard penetrating keratoplasty included the use of an 8.0-mm donor button sutured into a 7.5-mm recipient bed by means of two running 10-0 nylon sutures with 16 bites each. Before trephination of the recipient bed, superficial cauterization causing tissue shrinkage was applied to a 6-mm central area of the cornea of only 15 eyes (group A). The remaining 15 eyes (group B) did not undergo intraoperative cauterization. Before surgery, 6 months, and 13 months after surgery, a complete ophthalmologic examination was performed on each patient, including uncorrected and best-corrected visual acuity, refraction, keratometry, computerized corneal topography, as well as A-scan contact ultrasonography. MAIN OUTCOME MEASURES Postkeratoplasty refractive error was measured. RESULTS Both 6 months (sutures still in place) and 13 months (suture removal performed in all patients) after surgery, the average spherical equivalent was significantly less myopic in the patients undergoing cauterization. At 6 months, it was +1.72 diopters (D) +/- 1.13 D in group A and -3.16 D +/- 2.84 D in group B; at 13 months, it was +0.09 D 1.52 D in group A and -3.89 D +/- 3.01 D in group B. The average keratometric astigmatism also was significantly lower in group A than in group B both at 6 (2.5 D +/- 1.6 D vs. 4.1 D +/- 2.3 D) and 13 months (2.7 D +/- 1.5 D vs. 4.4 D +/- 2.4 D) after surgery. CONCLUSION Cauterization of the central cornea improves the postkeratoplasty refractive results of patients with keratoconus.
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Martin RG. Wedge resection in the cone after failed refractive surgery in a patient with keratoconus. J Cataract Refract Surg 1995; 21:348-50. [PMID: 7674175 DOI: 10.1016/s0886-3350(13)80145-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A 30-year-old man with keratoconus in the right eye had radial keratotomy in the left eye. Two pairs of corneal relaxing incisions (CRIs) were made in the right eye to flatten the central cornea and reduce high astigmatism. The right eye required an enhancement, and two additional arcuate CRIs were made. A corneal ulcer developed in the right eye, with infiltrates in the incision and corneal thinning. Although the second set of CRIs resulted in more regular astigmatism, the corneal thinning and ulcer caused regression at two months postoperatively. A wedge resection was performed to even the irregular astigmatism. The results are presented.
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Affiliation(s)
- R G Martin
- Carolina Eye Associates, Southern Pines, North Carolina 28387, USA
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Høvding G. Corneal astigmatism. The effect of transverse corneal incisions. ACTA OPHTHALMOLOGICA SCANDINAVICA 1995; 73:25-8. [PMID: 7627754 DOI: 10.1111/j.1600-0420.1995.tb00007.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The results of transverse or combined transverse and radial keratotomy in eyes with idiopathic corneal astigmatism (N = 11), astigmatism+myopia (N = 9) or early stages of keratoconus (N = 6) are presented. The corneal astigmatism was reduced in all our patients, the absolute reduction being significantly correlated to the degree of preoperative astigmatism (p = 0.007). In the whole study group the mean relative reduction of the corneal astigmatism was 52.7%. In eyes without keratoconus the astigmatism recorded at the last follow-up visit was very similar to that measured a few days after surgery, while greater changes occurred in the keratoconus group.
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Affiliation(s)
- G Høvding
- Department of Ophthalmology, University of Bergen, Norway
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Abstract
Transverse relaxing incisions were made in 12 eyes with a mean corneal astigmatism of 10.7D following penetrating keratoplasty. A few days later the mean graft astigmatism had been reduced to 5.5D (p = 0.0022), the reduction being significantly correlated to the degree of astigmatism before the keratotomy was done (p = 0.0044). Thereafter the corneal contour remained fairly stable through a mean follow-up period of 28.1 months, although a tendency towards a further reduction of the astigmatism was indicated. The mean corrected visual acuity improved from 0.5 before the keratotomy to 0.7 at the last control visit (p = 0.0117).
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Affiliation(s)
- G Høvding
- Department of Ophthalmology, University of Bergen, Norway
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Mortensen J, Öhrström A. Excimer Laser Photorefractive Keratectomy for Treatment of Keratoconus. J Refract Surg 1994. [DOI: 10.3928/1081-597x-19940501-12] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tuft SJ, Moodaley LC, Gregory WM, Davison CR, Buckley RJ. Prognostic factors for the progression of keratoconus. Ophthalmology 1994; 101:439-47. [PMID: 8127564 DOI: 10.1016/s0161-6420(94)31313-3] [Citation(s) in RCA: 232] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE The progression of keratoconus to a stage where penetrating keratoplasty (PK) is required for visual rehabilitation has considerable implications for affected patients. To assist with counselling, the authors have attempted to identify which factors measurable early in the course of the disease may indicate the likelihood of subsequent surgery. METHODS The authors reviewed the records of all patients who attended a single center over a 7-year period for contact lens management of their keratoconus. The influence of clinical variables on the time taken for the worst eye to progress to PK was evaluated by actuarial methods and multivariate analysis. RESULTS Included in the study were 2723 patients with a mean follow-up for unoperated eyes from the first visit of 4.5 years (range, 3 months to 28 years). Data were available for multivariate analysis in 2363 patients. At the end of the study period, 757 eyes (21.6% of all patients) had been grafted. The number of eyes progressing to PK was independently related to both the maximum and minimum keratometry, a corneal cylinder of more than 1.9 mm, the Snellen acuity, the racial group (P < 0.0001), and the age at presentation (P = 0.0006). Sex, laterality, systemic atopic disease, maternal or paternal age at birth, joint hypermobility, and a family history of keratoconus were not statistically related to outcome. Progression to PK in one eye increased the risk of progression in the contralateral eye (P < 0.0001) and a linear model of disease progression is proposed. CONCLUSIONS Several clinical variables can be measured in patients at the presentation of keratoconus that influence the probability of a subsequent PK.
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Affiliation(s)
- S J Tuft
- Moorfields Eye Hospital, London, England
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