[Options for contact correction after keratoplasty]

Keratoplasty is a radical surgical method for treating various corneal pathologies. Today, there are many types of keratoplasty, each aiming to restore the integrity and transparency of the cornea. However, keratoplasty-induced ametropia often prevents achieving high visual acuity and makes impossible the use of conventional optical correction methods such as glasses or soft and traditional rigid contact lenses. In this regard, the use of scleral contact lenses is the most optimal method for optical correction of postoperative refractive anomalies, ensuring successful visual rehabilitation and preventing the need for additional keratorefractive interventions.

Long-term Outcomes of a New Surgical Technique for Corneal Remodeling in Corneal Ectasia

PURPOSE

To analyze the outcomes of a new technique (corneal remodeling) to treat corneal ectasia.

METHODS

Sixty-nine cases that underwent corneal remodeling were analyzed. Anesthetic drops were instilled and a femtosecond laser platform was used to perform an 8-mm diameter keratectomy (180°, 270°, or 360°). Once ablation was completed, the edges of the resection were sutured with 8 to 12 interrupted stitches.

RESULTS

Three-year follow-up data are presented. The age of the population was 30.83 ± 12.65 years (range: 16 to 48 years). At 36 months postoperatively, 57.2% presented with uncorrected distance visual acuity (UDVA) of 20/100 or worse and 42.8% achieved between 20/80 and 20/40. After performing photorefractive keratectomy in 3 cases, 14.3% presented with UDVA of 20/100 or worse, 57.2% achieved between 20/80 and 20/40, and 28.5% achieved 20/30 or better in 180° arc length keratectomy. Most parameters compared were moderately to statistically significant (P < .05 to < .0000001).

CONCLUSIONS

Corneal remodeling is a safe technique that produces corneal flattening, reduction of anterior chamber depth, and decreased optical aberrations. It also offers a possibility to perform complementary refractive procedures. [J Refract Surg. 2019;35(4):261-267.].

Fourier Analysis of Single Running Suture Adjustment in Penetrating and Deep Lamellar Keratoplasty

PURPOSE

To prospectively evaluate clinical and visual results of running suture adjustment after keratoplasty.

METHODS

Thirty-seven eyes of 33 patients received running suture adjustment after keratoplasty. Changes in uncorrected visual acuity, distance best spectacle-corrected visual acuity (BSCVA), refraction, and Fourier analysis constituents were assessed before and after suture adjustment.

RESULTS

Thirty eyes, which had improvement of distance BSCVA soon after suture adjustment, maintained improvement at 1 year, whereas 7 eyes with decreased distance BSCVA soon after suture adjustment experienced no improvement at 1 year. Patients with poor distance BSCVA at 1 year had significantly higher high order irregularity than patients with better distance BSCVA despite similar cylindrical power outcomes.

Two-stage Laser in situ Keratomileusis to Correct Refractive Errors After Penetrating Keratoplasty

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.