Elsevier

Ophthalmology

Volume 107, Issue 6, June 2000, Pages 1125-1131
Ophthalmology

Penetrating keratoplasty for keratoconus: visual outcome and success1,

https://doi.org/10.1016/S0161-6420(00)00112-3Get rights and content

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.

Section snippets

Patients and methods

A retrospective review was conducted of patients with keratoconus who received a penetrating keratoplasty by one surgeon (DJC) from January 1988, to May 30, 1995. The sources of information were the Australian Corneal Graft Registry database, hospital records, and, where applicable, the records of optometrists and ophthalmologists who referred these patients. The data collected included patient demographic information, age at which penetrating keratoplasty was performed, surgical variables

Results

Outcome was assessed in terms of graft survival, postoperative complications, and visual rehabilitation as measured by Snellen and logMAR acuity, keratometry, residual cylinder, and method of correction.

Discussion

Penetrating keratoplasty for keratoconus was performed in relatively young patients (mean age, 31.6 years at the time of keratoplasty) with a slight male predominance of 55%. Thirty-two percent of our patients had a history of atopy.

Contact lens intolerance was the main indication for keratoplasty, and this is comparable to other series.11, 12 Forty-five percent of eyes were intolerant of contact lenses, and these patients depended on vision in the other eye before keratoplasty.

For bilateral

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    Supported by the Ophthalmic Research Institute of Australia.

    1

    The authors have no proprietary interest related to this article.

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