Three-year clinical outcome after penetrating keratoplasty for keratoconus with the guided trephine system

• Published in: American journal of ophthalmology Vol. 127; no. 6; pp. 666 - 673
• Main Authors: Ruhswurm, Irene, Scholz, Ursula, Pfleger, Thomas, Zehetmayer, Martin, Hanselmayer, Georg, Skorpik, Christian
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.1999; Elsevier
• Subjects: Adult; Biological and medical sciences; Cornea - surgery; Female; Follow-Up Studies; Humans; Keratoconus - surgery; Keratoplasty, Penetrating - instrumentation; Keratoplasty, Penetrating - methods; Male; Medical sciences; Middle Aged; Postoperative Complications - prevention & control; Prospective Studies; Refraction, Ocular; Refractive Errors - physiopathology; Refractive Errors - prevention & control; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Suture Techniques; Treatment Outcome; Visual Acuity; Human; Postoperative; Eye disease; Prognosis; Treatment; Keratoconus; Keratoplasty; Surgery; Visual acuity; Keratopathy
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/S0002-9394(99)00036-7

PURPOSE: To determine the long-term clinical outcome after keratoplasty with the guided trephine system in keratoconus eyes. METHODS: In a prospective study, all consecutive cases of penetrating keratoplasty had trephination performed with the guided trephine system, with which both donor and recipient cornea are trephined from the epithelial side with a same-sized blade. For wound closure, a double running antitorque suture technique with 10-0 nylon was used. Uncorrected and best-corrected Snellen visual acuity, subjective refraction, and astigmatism by keratometry were evaluated after final suture removal, 2 and 3 years postoperatively. RESULTS: In the 31 patients (31 eyes) enrolled, mean best-corrected visual acuity improved from 0.72 ± 0.16 (20/30) after final suture removal to 0.88 ± 0.15 (20/25) 3 years postoperatively ( P < .001). The mean spherical equivalent increased from −0.86 ± 2.10 diopters after final suture removal to −2.35 ± 2.65 diopters 3 years postoperatively ( P < .001). Mean keratometric astigmatism decreased from 4.68 ± 1.76 diopters after final suture removal to 3.57 ± 1.37 diopters 3 years postoperatively ( P = .001). Furthermore, an increase in mean keratometric levels with time ( P = .01) was observed and associated with myopic shift (r S = −.46, P = .008). CONCLUSION: With the guided trephine system, we attained favorable visual results, with prolonged improvement of visual acuity during the entire follow-up period. Our data show low and decreasing degrees of corneal astigmatism over time. During the follow-up period, a myopic shift was found after final suture removal. Nevertheless, this technique of performing same-sized grafts reduces postoperative residual myopia.