Corneal Topography-Guided Penetrating Keratoplasty and Suture Adjustment: New Approach for Astigmatism Control

Corneal Topography-Guided Penetrating Keratoplasty and Suture Adjustment: New Approach for Astigmatism Control

PURPOSE:To describe a new keratoplasty procedure using intraoperative topography to reduce postoperative astigmatism. METHODS:One hundred sixty-five eyes of 150 consecutive patients were enrolled in this prospective study. The most common diagnosis was keratoconus (78.8%). As many as 5.5% had post-l...

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Bibliographic Details
Published in:Cornea Vol. 26; no. 6; pp. 675 - 682
Main Authors: Vinciguerra, Paolo, Epstein, Daniel, Albè, Elena, Spada, Fernando, Incarnato, Nadia, Orzalesi, Nicola, Rosetta, Pietro
Format: Journal Article
Language:English
Published: United States Lippincott Williams & Wilkins, Inc 01-07-2007
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Astigmatism - prevention & control
Corneal Topography - methods
Female
Follow-Up Studies
Humans
Keratoplasty, Penetrating - methods
Male
Middle Aged
Monitoring, Intraoperative
Prospective Studies
Suture Techniques
Visual Acuity
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Summary:PURPOSE:To describe a new keratoplasty procedure using intraoperative topography to reduce postoperative astigmatism. METHODS:One hundred sixty-five eyes of 150 consecutive patients were enrolled in this prospective study. The most common diagnosis was keratoconus (78.8%). As many as 5.5% had post-laser in situ keratomileusis ectasia. Keratoplasty was performed with the Hanna Corneal Trephine System. A 24-bite running suture was placed, using a specially developed marker. Suture adjustment was performed with the aid of an intraoperative topographer (Keratron Scout; OPTIKON 2000, Rome, Italy). The aim of the adjustment was to obtain an astigmatism ≤2.0 D on the operating table. In case of >3.0 D of astigmatism at 1 month after surgery, suture adjustment was performed using the same intraoperative topographer. RESULTS:At 12 months postoperatevely (suture in), data from 108 (64%) eyes were available. The mean refractive astigmatism was 3.53 D, and the mean topographical astigmatism was 4.7 D. At 18 months (suture out), data from 32 eyes (19.4%) were available, and at 24 months, data from 29 eyes (13.3%) were available. The mean refractive astigmatism was 3.39 D at 18 months and 3.47 D at 24 months. The mean topographic astigmatism was 2.30 D at 18 months and 1.76 D at 24 months. Mean best spectacle-corrected visual acuity (BSCVA) was 0.51 at 3 months, 0.63 at 12 months (suture in), 0.67 at 18 months (suture out), and 0.78 at 24 months postoperatively. CONCLUSIONS:The combination of intraoperative topography and a 24-bite single running suture resulted in a stable astigmatism throughout the follow-up period, even after suture removal. BSCVA reached a 20/40 level as early as 3 months postoperatively and continued to rise after suture removal. The stability of astigmatism and BSCVA shortened the postoperative visual rehabilitation time and provided a high quality of vision early in the postoperative period.
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ISSN:0277-3740
1536-4798
DOI:10.1097/ICO.0b013e3180553bb2