Purpose: To assess the changes in corneal power and refraction due to sequential suture removal after penetrating keratoplasty (PK). DESIGN: Retrospective consecutive case series. METHODS: SETTING: Clinical practice. ...Purpose: To assess the changes in corneal power and refraction due to sequential suture removal after penetrating keratoplasty (PK). DESIGN: Retrospective consecutive case series. METHODS: SETTING: Clinical practice. STUDY POPULATION: We studied 67 phakic keratoconus eyes (central excimer laser trephination, primary keratoplasty, graft/recipient diameter 8.1/8.0 mm; double running suture) in this longitudinal study. MAIN OUTCOME MEASURES: Zeiss keratometry (equivalent power (KEQ), astigmatism (KAST)), corneal topography (equi-valent power (TEQ), astigmatism (TAST)) and subjective refractometry (spherical equivalent (SEQ), refractive cylinder (RAST)) were assessed with sutures in place (interval 1), with one suture out (interval 2), and with all sutures out (interval 3). OBSERVATION PROCEDURE: Corneal power and refraction was decomposed into vector components and the changes were derived between time stages. RESULTS: The mean follow-up period was 3.9 ±1.7 years. At interval 1, the axes of KAST/TAST/RAST were almost randomly distributed. At interval 2, the with/against the rule component of KAST/TAST/RAST decreased slightly and the oblique component increased significantly, so that the axes tended to have a preferred oblique direction. At interval 3, the with/against the rule component of KAST/TAST/RAST increased slightly and the oblique component decreased significantly, so that the with/against the rule component exceeded the oblique component by approximately 23%/28%/25%. Median KEQ/ TEQ/SEQ changed by 0.64/0.62/-1.11 diopters (interval 1 to interval 2) and by -0.85/-0.90/1.56 diopters (interval 2 to interval 3). CONCLUSIONS: As a result of removal of the first running suture, corneal astigmatismas well as the refractive cylinder tend to oblique axes. As a result of removal of the second running suture, the final corneal astigmatism and refractive cylinder tend to orientation axes with/against the rule.展开更多
Puprose: It is a challenge to prevent irreversible amblyopia in infants suffering from Peters anomaly. In some cases of centrally located corneal opacifications an optical sector iridectomy can not lead to a clear opt...Puprose: It is a challenge to prevent irreversible amblyopia in infants suffering from Peters anomaly. In some cases of centrally located corneal opacifications an optical sector iridectomy can not lead to a clear optical axis. The homologous penetrating keratoplasty as early surgical procedure has shown an extremely poor outcome with a high risk of irreversible graft failure. We report on the autologous ipsilateral rotating penetrating keratoplasty in an eight- week- old infant suffering from Peters anomaly. Patients: An autologous ipsilateral rotating penetrating keratoplasty was performed in an eight- week- old infant suffering from Peters anomaly to prevent irreversible amblyopia. Results: After a follow- up time of 8 months we saw a clear graft within the optical axis without any complications in wound healing. We removed the single sutures two months after keratoplasty. Postoperative astigmatism could be corrected first by fitting a special nursery contact lens and after reduction of astigmatismbecause of suture removalwe fitted special nursery glasses. The intraocular pressure remained within the normal range during the follow- up period. Conclusion: The autologous ipsilateral rotating penetrating keratoplasty should be considered superior to homologous keratoplasty in infants withPeters anomaly if sector iridectomy is not advisable because of a central corneal opacification. Resulting high refractive errors can be successfully corrected by special contact lens fitting or by nursery glasses.展开更多
文摘Purpose: To assess the changes in corneal power and refraction due to sequential suture removal after penetrating keratoplasty (PK). DESIGN: Retrospective consecutive case series. METHODS: SETTING: Clinical practice. STUDY POPULATION: We studied 67 phakic keratoconus eyes (central excimer laser trephination, primary keratoplasty, graft/recipient diameter 8.1/8.0 mm; double running suture) in this longitudinal study. MAIN OUTCOME MEASURES: Zeiss keratometry (equivalent power (KEQ), astigmatism (KAST)), corneal topography (equi-valent power (TEQ), astigmatism (TAST)) and subjective refractometry (spherical equivalent (SEQ), refractive cylinder (RAST)) were assessed with sutures in place (interval 1), with one suture out (interval 2), and with all sutures out (interval 3). OBSERVATION PROCEDURE: Corneal power and refraction was decomposed into vector components and the changes were derived between time stages. RESULTS: The mean follow-up period was 3.9 ±1.7 years. At interval 1, the axes of KAST/TAST/RAST were almost randomly distributed. At interval 2, the with/against the rule component of KAST/TAST/RAST decreased slightly and the oblique component increased significantly, so that the axes tended to have a preferred oblique direction. At interval 3, the with/against the rule component of KAST/TAST/RAST increased slightly and the oblique component decreased significantly, so that the with/against the rule component exceeded the oblique component by approximately 23%/28%/25%. Median KEQ/ TEQ/SEQ changed by 0.64/0.62/-1.11 diopters (interval 1 to interval 2) and by -0.85/-0.90/1.56 diopters (interval 2 to interval 3). CONCLUSIONS: As a result of removal of the first running suture, corneal astigmatismas well as the refractive cylinder tend to oblique axes. As a result of removal of the second running suture, the final corneal astigmatism and refractive cylinder tend to orientation axes with/against the rule.
文摘Puprose: It is a challenge to prevent irreversible amblyopia in infants suffering from Peters anomaly. In some cases of centrally located corneal opacifications an optical sector iridectomy can not lead to a clear optical axis. The homologous penetrating keratoplasty as early surgical procedure has shown an extremely poor outcome with a high risk of irreversible graft failure. We report on the autologous ipsilateral rotating penetrating keratoplasty in an eight- week- old infant suffering from Peters anomaly. Patients: An autologous ipsilateral rotating penetrating keratoplasty was performed in an eight- week- old infant suffering from Peters anomaly to prevent irreversible amblyopia. Results: After a follow- up time of 8 months we saw a clear graft within the optical axis without any complications in wound healing. We removed the single sutures two months after keratoplasty. Postoperative astigmatism could be corrected first by fitting a special nursery contact lens and after reduction of astigmatismbecause of suture removalwe fitted special nursery glasses. The intraocular pressure remained within the normal range during the follow- up period. Conclusion: The autologous ipsilateral rotating penetrating keratoplasty should be considered superior to homologous keratoplasty in infants withPeters anomaly if sector iridectomy is not advisable because of a central corneal opacification. Resulting high refractive errors can be successfully corrected by special contact lens fitting or by nursery glasses.
