Original article
Repeat Keratoplasty for Correction of High or Irregular Postkeratoplasty Astigmatism in Clear Corneal Grafts

https://doi.org/10.1016/j.ajo.2004.12.008Get rights and content

Purpose

To evaluate the functional results of repeat penetrating keratoplasty in clear corneal grafts with high/irregular postkeratoplasty astigmatism.

Design

Retrospective, longitudinal, single-center, consecutive clinical case series.

Methods

We studied 17 eyes (16 keratoconus, 1 Fuchs’ dystrophy) of 16 patients (age, 54.9 ± 12.6 years). They were treated with repeat PK, performed using the 193-nm Zeiss-Meditec MEL-60 excimer laser using round metal masks (diameter, 7.5–8.0 mm), and employing double running sutures. main outcome measures: Subjective refractometry, standard keratometry, and corneal topography (Tomey TMS-1) were used to assess best-corrected visual acuity (BCVA), spherical equivalent (SEQ), keratometric and topographic central corneal power (CP), refractive, keratometric and topographic astigmatism, surface regularity index (SRI), surface asymmetry index (SAI), and potential visual acuity (PVA) preoperatively, before and after first suture removal (1.1 year), and after second suture removal (1.8 years).

Results

Visual acuity improved significantly (BCVA from 0.2–0.5, P = .04 or better) for all postoperative measurements. CP decreased significantly, but SEQ did not change. All measures of astigmatism and SRI and SAI values showed postoperative improvement with sutures in place; however, astigmatism increased significantly after second suture removal.

Conclusions

With all-sutures-in, BCVA and astigmatism improve significantly after repeat PK for high/irregular astigmatism. However, to present significant increase in astigmatism, final suture removal should be postponed as long as possible in such eyes.

Section snippets

Patient and donor details

This retrospective study was a longitudinal, single-center, clinical, nonrandomized, consecutive case series. The study population consisted of 17 consecutive eyes of 16 patients (10 eyes of 10 males; 7 eyes of 6 females. Patient age was 54.9 ± 12.6 years (range, 36.1–76.0 years). The diagnosis was keratoconus (16 eyes of 15 patients) and Fuchs’ dystrophy (1 eye). Nine of the operated eyes (53%) were left eyes. Two of the donor corneas (12%) had been preserved in organ culture. Other donor

Results

From examination of the preoperative photographs, the graft was classified as “eccentric” (range, 0.3–1.2 mm) in 10 eyes (71%). The graft-host junction was in no case located at the optical axis or the limbus.

The pre- and postoperative values of the outcome parameters are shown in Table.

Twelve months after PK (with all sutures still present), BCVA and PVA were significantly improved (P = .04 or better), from preoperative values of 0.2/0.5 to 0.5/0.7, respectively. Central corneal power

Discussion

Postkeratoplasty astigmatism often impedes visual rehabilitation of patients after corneal transplantation, even with clear grafts. Twelve months after PK (before suture removal), and also after first and after second suture removal, BCVA, PVA, and (before final suture removal) mean astigmatism measures showed significant improvement compared with preoperative mean values (Table). However, after removal of the second suture, astigmatism again increased significantly. Thus, the most conspicuous

Since graduating in 1999 from the Semmelweis University in Budapest, Hungary, Dr. Nópra Szentmáry has worked at the 1st Department of Ophthalmology of the University and since 2000 has been performing research work at this clinic and at the University of Erlangen, Germany. Primary research interest: wound healing of the cornea.

References (30)

  • E.M. Perlman

    An analysis and interpretation of refractive errors after penetrating keratoplasty

    Ophthalmology

    (1981)
  • B. Seitz et al.

    Astigmatismus bei keratoplastik

  • B. Seitz et al.

    Dezentrierung der Spenderhornhaut bei mechanischer und Excimerlaser Trepanation für die perforierende Keratoplastik

    Klin Monatsbl Augenheilkd

    (2000)
  • A. Fronterre et al.

    Relaxing incisions for postkeratoplasty astigmatism

    Cornea

    (1991)
  • G.A. Lee et al.

    Effects of lamellar keratotomy on postkeratoplasty astigmatism

    Br J Ophthalmol

    (2003)
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      In 3 patients, in spite of minimal reductions in keratometric astigmatism, an improvement in spectacle tolerance was still observed, leading the authors to conclude the procedure was successful in reducing irregular astigmatism. If these methods are deemed inappropriate or fail, repeat keratoplasty is an option.142,186 Patel and coworkers described a series of 15 eyes in 13 patients that underwent repeat PK for late ectasia.142

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    Since graduating in 1999 from the Semmelweis University in Budapest, Hungary, Dr. Nópra Szentmáry has worked at the 1st Department of Ophthalmology of the University and since 2000 has been performing research work at this clinic and at the University of Erlangen, Germany. Primary research interest: wound healing of the cornea.

    Supported in part by the German Ministry for Education and Research (BMBF, IZKF Erlangen, Project B13), by the Neurocenter Erlangen, Erlangen, Germany and by a travel grant from the Society of European Ophthalmologists (SOE), London, Great Britain.

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