Outcomes of Same-Sizing versus Oversizing Donor Trephines in Keratoconic Patients Undergoing First Penetrating Keratoplasty

• Published in: Ophthalmology (Rochester, Minn.) Vol. 115; no. 2; pp. 268 - 275
• Main Authors: Jaycock, Philip D., MD, MRCOphth, Jones, Mark N.A., MSc, Males, John, FRANZCO, Armitage, W. John, PhD, Cook, Stuart D., PhD, FRCOphth, Tole, Derek M., MRCOphth, Kaye, Stephen B., MD, FRCOphth
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-02-2008; Elsevier
• Subjects: Adult; Biological and medical sciences; Cornea - pathology; Diseases of cornea, anterior segment and sclera; Female; Follow-Up Studies; Graft Survival; Humans; Keratoconus - surgery; Keratoplasty, Penetrating - methods; Male; Medical sciences; Miscellaneous; Myopia - prevention & control; Ophthalmology; Postoperative Complications; Retrospective Studies; Tissue Donors; Treatment Outcome; Visual Acuity; Human; Prognosis; Keratopathy; Penetrating graft; Eye disease; Treatment; Donor; Keratoconus; Keratoplasty; Surgery; Evolution; Ophthalmology; Anterior segment disease; Comparative study
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/j.ophtha.2007.04.051

Purpose To investigate whether use of same-size donor and recipient trephines reduced myopia after penetrating keratoplasty for keratoconus. Design Retrospective cohort study. Participants Eight hundred seventy-eight first grafts for keratoconus were reported to UK Transplant between April 1999 and December 2003. There were 234 and 644 grafts in the same-size and oversize donor trephine groups, respectively. At 1 year, mean spherical equivalent (SE) data were available for 116 eyes (50%) and 295 eyes (46%) in the same-size and oversize groups. At 2 years, mean SE data were available for 64 eyes (27%) and 148 eyes (23%) in the same-size and oversize groups. Methods Logistic regression and univariate analysis of follow-up data submitted to UK Transplant. Main Outcome Measures At 1 and 2 years postoperatively, mean SE, magnitude of the cylindrical component of the refraction, postoperative uncorrected visual acuity (VA), postoperative best-corrected VA, and postoperative complications were recorded. Results The mean SEs for the same-size and oversize donor trephine groups, respectively, were −1.45 diopters (D) and −1.41 D at 1 year ( P = 0.6) and −1.74 D and −2.19 D at 2 years postoperatively ( P = 0.3). Although there were no differences in graft survival between the groups at 1 and 2 years, there was a higher incidence of postoperative wound leaks in the same-size group ( P = 0.03). Conclusion Use of same-size donor and recipient trephines did not reduce myopia and was associated with an increased risk of postoperative complications.