Long - Term Results of the Postoperative Ametropia Correction after Perforating Keratoplasty Using the LASIK Method
Authors:
M. Horáčková; V. Loukotová; Z. Hlinomazová; E. Vlková
Authors‘ workplace:
Oftalmologická klinika LF MU a FN Brno Bohunice, přednosta prof. MUDr. Eva Vlková
Published in:
Čes. a slov. Oftal., 64, 2008, No. 1, p. 3-10
Overview
The postoperative refractive error after otherwise successful perforating keratoplasty (PK), often negatively influents the visual acuity. The authors refer about the results of postoperative ametropia correction by means of the LASIK method. There were 43 eyes of 38 patients in the study group. In 41 eyes, there was myopia with myopic astigmatism, and in two eyes, the hyperopia with hyperopic astigmatism were present. The average age of the group was 35.6 ± 10.5 years (24–87 years), and the follow-up period was 27.4 ± 22.9 months (maximum, 95 months). The average spherical refractive error before the LASIK procedure was -2.67 ± 3.66 D, and preoperative subjective astigmatism -5.14 ±2.81 Dcyl. The average astigmatism established by means of corneal topography was 5.16 ± 2.45. Dcyl. LASIK was performed during one session using the excimer laser Keracor 117 (Chiron) or Technolas 217 (Bausch & Lomb). For the lamellar keratectomy the authors used the mechanical LKS (Moria) and the automatic ACS keratome (Chiron). For the corneal topography examination, the ORBSCAN II (Bausch & Lomb) machine was used. The authors evaluated 1) the development of the postoperative refraction, 2) the change of the axis of the astigmatism induced by LASIK, 3) the development of the uncorrected visual acuity (UCVA), 4) the final uncorrected and best-corrected visual acuity (UCVA and BCVA), 5) the change of the endothelial cells’ density after LASIK, and 6) the occurrence of per- and postoperative complications. At the last postoperative control, the average of the spherical refractive error was -0.17 ± 1.01 D, subjective astigmatism was -1.58 ± 2.03 Dcyl, and topographical astigmatism was 3.62 ± 2.06 Dcyl (t-test, p < 0.001). We reduced the spherical refractive error by 93.6 %, subjective astigmatism by 69.3 %, and topographical astigmatism by 29.8 % only. In 14 eyes (32.6 %) the change of the axis was recorded – so called surgically induced astigmatism – the average value was 30.8 ± 19.8 degrees (t-test, p > 0.05). The final UCVA 0.5 and better was reached by 74.4 % of eyes (t-test, p < 0.001) and BCVA 0.5 and better in 83.8 % of eyes (t-test, p < 0.05). The postoperative UCVA improved according to the preoperative one in 95.3 % of cases, the BCVA in 37.2 % of cases (by means of gain of lines on the Snellen chart). During the follow - up period the authors didn’t prove statistically significant decrease of the endothelial cells’ density (CD) according to the LASIK procedure (t-test, p > 0.05). Peroperatively, the authors noticed small defect of the lamella 4 times, and total lamellar detachment 2 times. Postoperatively, in 6 eyes a slight fibrosis occurred, and in two cases, the late rejection of the corneal transplant was diagnosed. The keratoconus relapsed 12 months after the procedure in 2 eyes and was indicated to rekeratoplasty. LASIK is an effective and relatively safe method for postoperative refractive error correction after perforating keratoplasty.
Key words:
perforating keratoplasty, astigmatism, LASIK, keratoconus
Sources
1. Buzard, K., Febbraro, J.L., Fundingsland, B.R.: Laser in situ keratomileusis for the correction of residual ametropia after penetrating keratoplasty. J Cataract Refract Surg., 30, 2004, 5: 1006-1013.
2. Cosar, C. B., Acar, S.: Topography-guided LASIK with the wavelight laser after penetrating keratoplasty. J Refract Surg., 22, 2006, 7: 716 -719.
3. Dursun, D., Forster, R.K., Feuer, W.J.: Surgical technique for control of postkeratoplasty myopia, astigmatism, and anisometropia. Am J Ophthalmol., 135, 2003: 807-815.
4. Erich, D., Duncker, G.I.: The use of intracorneal rings in penetrating keratoplasty. Klin Monatsbl Augenheilkd., 221, 2004, 2: 92-95.
5. Filipec, M., Holubová, A., Klemensová, R.: Korekce refrakčních vad po parciální perforující keratoplastice metodou LASIK. Sborník abstrakt XIII. výročního sjezdu ČOS, 2005: 114.
6. Filipec, M., Holubová, A., Martincová, R.: Možnosti korekce vysokých ametropií po perforující keratoplastice fakickou čočkou. Sborník abstrakt XIV. výročního sjezdu ČOS, 2006: 109.
7. Galal, A.: Head-to-head comparison favour two-step technique for LASIK after PKP. Eurotimes, 11, 2006, 6: 17.
8. Geggel, H.S.: Arcuate relaxing incisions guided by corneal topography for postkeratoplasty astigmatism: vector and topographic analysis. Cornea, 25, 2005, 5: 545- 57.
9. Hardten, D. R., Chittcharus, A., Lindstrom, R.L.: Long-term analysis of LASIK for the correction of refractive errors after penetrating keratoplasty. Trans Am Ophthalmol. Soc., 100, 2002: 143-150.
10. Hlinomazová, Z., Vlková, E., Horáčková, M. et al.: Endoteliální analýza u rohovkových transplantací. Sborník abstrakt XII. výročního sjezdu ČOS s mezinárodní účastí, 2004: 37.
11. Horáčková,M., Loukotová, V., Hlinomazová, Z.. et al.: Dlouhodobé výsledky korekce pooperační ametropie po perforující keratoplastice metodou LASIK. Sborník abstrakt XIII. výročního sjezdu ČOS, 2005: 115.
12. Krumreich, H.H., Duncker, G.: Intrastromal corneal ring in penetrating keratoplasty: evidence-based update 4 years after implantation. J Cataract Refract Surg., 32, 2006, 6: 993-998.
13. Lorencová, V., Urminský, J., Rozsíval, P.: Řešení komplikované katarakty implantací torické nitrooční čočky. Sborník abstrakt 3. bilaterálního česko-slovenského oftalmologického sympozia, 2005:72.
14. Mularoni, A., Laffi, G. L., Bassein, L. et al.: Two-step LASIK with topography-guided ablation to correct astigmatism after penetrating kertoplasty. J Refract Surg., 22, 2006,1: 67-74.
15. Nuijts, R., DeVries, N.: Progressive corneal steepening after Artisan toric IOL implantation for postkeratoplasty ametropia. Eurotimes, 11, 2006, 8: 28.
16. Peško, K., Oláh, Z. Problém astigmatizmu po perforujúcej keratoplastike. I. príčiny vzniku. Čes. a slov.Oftal., 58, 2002, 4: 278-282.
17. Peško, K., Oláh, Z.: Problém astigmatizmu po perforujúcej keratoplastike. II. management stehmi podmieneného astigmatizmu. Čes. a slov. Oftal., 58, 2002, 5: 330-334.
18. Peško, K., Oláh, Z.: Problém astigmatizmu po perforujúcej keratoplastike. III. Chirurgický management astigmatizmu po vybratí všetkých stehov. Čes. a slov. Oftal.,59, 2003,1: 52-59.
19. Poole, T.R., Ficker, L.A.: Astigmatic keratotomy for post-keratoplasty astigmatism. J Cataract Refract Surg., 32, 2006, 7: 1175-1179.
20. Rajan, M.S., O’Brart, D.P., Patel, P. et al.: Topography-guided customized laser-assisted subepithelial keratectomy for the treatment of postkeratoplasty astigmatism. J Cataract Refract Surg., 32, 2006, 6: 949-957.
21. Tahzib, N.G., Cheby, Z.Z., Nuijts, R.M.: Three-year follow-up analysis of Artisan toric lens implantation for correction of postkeratoplasty ametropia in phakic and pseudophakic eyes. Ophthalmology, 113, 2006, 6: 976-984.
22. Touzeau, O., Borderie, V., Loison, K. et al.: Correlation between corneal topography and subjective refraction in idiopathic and surgery-induced astigmatism. J Fr Ophthalmol., 24, 2001, 2: 129-138.
23. Touzeau, O., Allouch, C., Borderie, V. et al.: Long- term refractive and topographic changes after penetrating keratoplasty. J Fr Ophthalmol., 26, 2003, 5: 465-469.
24. Urminský, J., Rozsíval, P., Lorencová, V. et al.: Vliv adjustace pokračujícího rohovkového stehu na cylindrickou refrakci po perforující keratoplastice. Čes .a slov. Oftal., 60, 2004, 2: 124-132.
25. Vlková, E., Horáčková, M., Hlinomazová, Z., Neugebauerová, T.: Řešení pooperačního astigmatismu po perforující keratoplastice metodou LASIK. Čes. a slov. Oftal., 56, 2000, 6: 370-374
26. Walker, N.J., Apel, A.J.: Effect of hinged lamellar keratotomy on post-keratoplasty astigmatism and vision. Clin Experiment Ophthalmol., 32, 2004, 2: 147-153.
27. Weber, S.K., Lawless, M.A., Sutton, G.L. et al.: LASIK for post-penetrating keratoplasty astigmatism and myopia. Br J Ophthalmol., 83, 1999: 1013-1018.
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OphthalmologyArticle was published in
Czech and Slovak Ophthalmology
2008 Issue 1
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