8.5/8.6-mm Excimer Laser-Assisted Penetrating Keratoplasties in a Tertiary Corneal Subspecialty Referral Center: Indications and Outcomes in 107 Eyes.
Journal
Cornea
ISSN: 1536-4798
Titre abrégé: Cornea
Pays: United States
ID NLM: 8216186
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
pubmed:
9
4
2020
medline:
27
4
2021
entrez:
9
4
2020
Statut:
ppublish
Résumé
To report the indications and outcomes of 8.5/8.6-mm excimer laser-assisted penetrating keratoplasties (PKPs) at a tertiary corneal subspecialty referral center. This retrospective, descriptive, observational study included 107 PKPs performed in 96 patients (mean age, 53 ± 12 years). The patients' indications for surgery, best-corrected visual acuity, surface regularity index, surface asymmetry index, topographic astigmatism, central endothelial cell density, central corneal thickness, and graft status were recorded preoperatively, 6 weeks postoperatively, and before (12 ± 2 months) and after (19 ± 4 months) the suture removal. The surgeries included 48 primary PKPs and 59 repeat PKPs. The main indications were corneal ectatic disorders (50%), severe corneal keratitis (21%), and corneal scars (16%) in the primary PKP group and highly irregular astigmatism after PKP (51%) and previous graft decompensation (37%) in the repeat PKP group. From preoperative measurements to the last follow-up visit without sutures, we found significant improvements (P < 0.001 for all) in visual acuity (0.7 ± 0.3 LogMAR to 0.3 ± 0.2 LogMAR), surface regularity index (1.5-1.0), and surface asymmetry index (2.59-1.1). At the last follow-up, the mean outcome measurements did not significantly differ between the primary and repeat PKP groups. Overall, 89 grafts (83%) remained clear at the last follow-up. In cases of ectatic disorders and highly irregular astigmatism after keratoplasty, 8.5/8.6-mm excimer laser-assisted PKP seems to be an excellent treatment option, achieving a significant improvement in visual acuity.
Identifiants
pubmed: 32265385
doi: 10.1097/ICO.0000000000002327
pii: 00003226-202007000-00002
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
806-811Références
Eye Bank Association of America. Statistical Report on Eye Banking Activity for 2015. Eye Bank Association of America; 2016. Available at: http://restoresight.org/wp-content/uploads/2016/03/2015-Statistical-Report.pdf. Accessed February 16, 2019.
Flockerzi E, Maier P, Böhringer D, et al. Trends in corneal transplantation from 2001 to 2016 in Germany: a report of the DOG–section cornea and its keratoplasty registry. Am J Ophtalmol. 2018;188:91–98.
Hannush SB, Riveroll-Hannush L. Preoperative considerations and decision-making in keratoplasty. In: Mannis MJ, Holland EJ, eds. Cornea: Fundamentals, Diagnosis and Management. 4th ed. New York, NY: Elsevier Mosby; 2016:1256–1263.
Seitz B, Langenbucher A, Hager T, et al. Penetrating keratoplasty for keratokonus—excimer versus femtosecond laser trephination. Open Ophthalmol J. 2017;11:225–240.
Mader T, Stulting D. The high risk penetrating keratoplasty. Ophthalmol Clin North Am. 1991;4:411–426.
Speaker M, Arentsen J, Laibson P. Long-term survival of large diameter penetrating keratoplasty for keratoconus and pellucid marginal degeneration. Acta Ophthalmol. 1989;67:17–19.
Seitz B, Szentmáry N, Langenbucher A, et al. PKP for keratoconus—from hand/motor trephine to excimer laser and back to femtosecond laser [in German]. Klin Monbl Augenheilkd. 2016;233:727–736.
Tóth G, Szentmáry N, Langenbucher A, et al. Comparison of excimer laser versus femtosecond laser assisted trephination in penetrating keratoplasty: a retrospective study. Adv Ther. 2019;36:3471–3482.
Seitz B, Langenbucher A, Kus MM, et al. Nonmechanical corneal trephination with the excimer laser improves outcome after penetrating keratoplasty. Ophthalmology. 1999;106:1156–1164.
Seitz B, Szentmáry N, El-Husseiny M, et al. The penetrating keratoplasty (PKP)—a century of success. In: Hjortdal J, ed. Corneal Transplantation. Basel, Switzerland: Springer Internationa; 2016:67–92.
Szentmáry N, Langenbucher A, Naumann GOH, et al. Intra-individual variability of penetrating keratoplasty outcome after excimer laser versus motorized corneal trephination. J Refract Surg. 2006;22:804–810.
Hoffmann F. Suture technique for perforating keratoplasty [in German]. Klin Monbl Augenheilkd. 1976;169:584–590.
Seitz B, Langenbucher A, Zagrada D, et al. [Corneal dimensions in various types of corneal dystrophies an their effect on penetrating keratoplasty [in German] Klin Monbl Augenheilkd. 2000;217:152–158.
Seitz B, Langenbucher A, Küchle M, et al. Impact of graft diameter on corneal power and the regularity of postkeratoplasty astigmatism before and after suture removal. Ophthalmology. 2003;110:2162–2167.
Skeens HM, Holland EJ. Large-diameter penetrating keratoplasty: indications and outcomes. Cornea. 2010;29:296–301.
Awwad ST, Parmar DN, Heilman M, et al. Results of penetrating keratoplasty for visual rehabilitation after Acanthamoeba keratitis. Am J Ophthalmol. 2015;140:1080–1084.
Szentmáry N, Daas L, Shi L, et al. Acanthamoeba keratitis—clinical signs diagnosis and treatment [in German]. Klin Monatsbl Augenheilkd. 2018;235:671–677.
Laurik KL, Szentmáry N, Daas L, et al. Early penetrating keratoplasty à chaud may improve outcome in therapy-resistant acanthamoeba keratitis. Adv Ther. 2019;36:2528–2540.
Szentmáry N, Seitz B, Langenbucher A, et al. Repeat keratoplasty for correction of high or irregular postkeratoplasty astigmatism in clear corneal grafts. Am J Ophthalmol. 2005;139:826–830.
Seitz B, Hager T, Langenbucher A, et al. Reconsidering sequential double running suture removal after penetrating keratoplasty: a prospective randomized study comparing excimer laser and motor trephination. Cornea. 2018;37:301–306.
Cheng YY, Visser N, Schouten JS, et al. Endothelial cell loss and visual outcome of deep anterior lamellar keratoplasty versus penetrating keratoplasty: a randomized multicenter clinical trial. Ophthalmology. 2011;118:302–309.
Langenbucher A, Seitz B, Nguyen NX, et al. Corneal endothelial cell loss after nonmechanical penetrating keratoplasty depends on diagnosis. A regression analysis. Graefes Arch Clin Exp Ophthalmol. 2002;5:387–392.
Tóth G, Butskhrikidze T, Seitz B, et al. Endothelial cell density and corneal graft thickness following excimer laser vs. femtosecond laser-assisted penetrating keratoplasty—a prospective randomized study. Graefes Arch Clin Exp Ophthalmol. 2019;257:975–981.