Visual Rehabilitation After Penetrating Keratoplasty

Abstract

Objectives: Here, our aim was to report our treatment strategies and their results performed for visual rehabilitation after penetrating keratoplasty.

Materials and Methods: The medical records of 98 patients (54 male/44 female), with results from 104 eyes, who underwent penetrating keratoplasty between January 2013 and January 2015 at the Baskent University Faculty of Medicine, Department of Ophthalmology were reviewed. Patient age, indication for penetrating keratoplasty, interventions performed for visual rehabilitation, follow-up duration, topo graphic and refractive astigmatism at the end of follow-up, and final best corrected visual acuity results were recorded.

Results: Mean age of patients was 54 +/- 23 years. Indications for penetrating keratoplasty included keratoconus, Fuchs endothelial dystrophy, pseu dophakic bullous keratopathy, and corneal scarring. The mean duration of follow-up was 23 +/- 11.5 months. Topography-guided suture adjustment and selective suture removal were performed 2 to 6 weeks and after 3 months in eyes with more than 3 diopters of corneal astigmatism in patients who had continuous and interrupted sutures. Spectacle correction was administered for 86 eyes (83%), and contact lenses including rigid gas-permeable and scleral lenses were fitted in 18 eyes (17%) in patients who were unsatisfied with spectacle correction. Relaxing corneal incisions were performed in 23 eyes (22%), and toric intraocular lens implantations were performed in 34 eyes (33%) with cataracts. The mean topographic and absolute refractive astigmatism at the end of followup was 3.4 +/- 2.6 and 3.6 +/- 1.9 diopters.

Conclusions: Topography-guided suture adjustment and selective suture removal are effective for minimizing early postoperative astigmatism. If significant astigmatism remains after suture removal, which cannot be corrected by optical means, then further surgical procedures including relaxing incisions and toric intraocular lens implantation can be performed.