Conductive Keratoplasty and the Coupling Phenomenon

Effects of optically imposed astigmatism on early eye growth in chicks

PURPOSE

To determine the effects of optically imposed astigmatism on early eye growth in chicks.

METHODS

5-day-old (P5) White Leghorn chicks were randomly assigned to either wear, monocularly, a "high magnitude" (H: +4.00DS/-8.00DC) crossed-cylindrical lens oriented at one of four axes (45, 90, 135, and 180; n = 20 in each group), or were left untreated (controls; n = 8). Two additional groups wore a "low magnitude" (L: +2.00DS/-4.00DC) cylindrical lens orientated at either axis 90 or 180 (n = 20 and n = 18, respectively). Refractions were measured at P5 and after 7 days of treatment for all chicks (P12), whereas videokeratography and ex-vivo eyeshape analysis were performed at P12 for a subset of chicks in each group (n = 8).

RESULTS

Compared to controls, chicks in the treatment groups developed significant amounts of refractive astigmatism (controls: 0.03 ± 0.22DC; treatment groups: 1.34 ± 0.22DC to 5.51 ± 0.26DC, one-way ANOVAs, p ≤ 0.05) with axes compensatory to those imposed by the cylindrical lenses. H cylindrical lenses induced more refractive astigmatism than L lenses (H90 vs. L90: 5.51 ± 0.26D vs. 4.10 ± 0.16D; H180 vs. L180: 2.84 ± 0.44D vs. 1.34 ± 0.22D, unpaired two-sample t-tests, both p ≤ 0.01); and imposing with-the-rule (H90 and L90) and against-the-rule astigmatisms (H180 and L180) resulted in, respectively, steeper and flatter corneal shape. Both corneal and internal astigmatisms were moderately to strongly correlated with refractive astigmatisms (Pearson's r: +0.61 to +0.94, all p ≤ 0.001). In addition, the characteristics of astigmatism were significantly correlated with multiple eyeshape parameters at the posterior segments (Pearson's r: -0.27 to +0.45, all p ≤ 0.05).

CONCLUSIONS

Chicks showed compensatory ocular changes in response to the astigmatic magnitudes imposed in this study. The correlations of changes in refractive, corneal, and posterior eyeshape indicate the involvement of anterior and posterior ocular segments during the development of astigmatism.

Conductive keratoplasty

PURPOSE OF REVIEW

Conductive keratoplasty is a noninvasive, in-office procedure for the correction of hyperopia, hyperopic astigmatism, and management of presbyopia. It serves as an alternative to laser-based refractive surgery with essentially no intraoperative or postoperative complications.

RECENT FINDINGS

In the past decade, photorefractive keratectomy and laser in-situ keratomileusis have been the most popular refractive surgical procedures to correct myopia, hyperopia and astigmatism. Although relatively safe, flap-related complications often result in undesirable visual acuity. Since US Food and Drugs Administration approval in 2002, conductive keratoplasty has become a promising technique to correct low to moderate hyperopia and astigmatism. The procedure was first used by Mendez and colleagues in 1993. It is a nonlaser, no cutting procedure that delivers radio-frequency energy to corneal stroma in a circular fashion to steepen the cornea. Multiple studies have shown that conductive keratoplasty offers equal or superior efficacy, predictability, stability and safety than currently used refractive procedures to correct hyperopia or hyperopic astigmatism. In addition, monovision conductive keratoplasty has been shown to be successful for the management of presbyopia.

SUMMARY

Conductive keratoplasty, an alternative to the laser-based procedure, is effective, predictable, and safe to correct low to moderate hyperopia, astigmatism, and manage presbyopia.