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Impressum
Outcome after penetrating keratoplasty comparing keratoconus and Fuchs' dystrophy
Seitz B., Langenbucher A., Küchle M., Naumann G. O. H.
Department of Ophthalmology, University of Erlangen-Nürnberg, Schwabachanlage 6, D-91054 Erlangen
Background and Objective: Keratoconus (K) und Fuchs' dystrophy
(F) are by far the leading indications for penetrating keratoplasty (PK)
in our hospital. The purpose of this study was to assess the differences
concerning astigmatism, topographic regularity and visual acuity after
PK comparing K and F.
Patients and Methods: Inclusion criteria for this prospective,
cross-sectional, clinical study included: (1) One surgeon, (2) Central
round PK without previous surgery, (3) F (7.5/7.6 mm, n=73) or K (8.0/8.1
mm, n=106), (4) Double running cross-stitch suture. Exclusion criteria
were (1) Maculopathies, (2) Optic atrophies, or (3) Amblyopias. In 179
patients (mean age 51±18 years) PK was attributed randomly either
to 193 nm Meditec excimer laser trephination along metal masks (50 K,
32 F) or to motor trephination (Mikrokeratron, Geuder) (53 K, 35 F). In
69% of F a triple procedure was performed. Main outcome measures included:
1) keratometric netto astigmatism, 2) surface regularity index (SRI) and
surface asymmetry index (SAI) of the TMS-1 topographer, 3) best-corrected
visual acuity and spherical equivalent (SEQ) - each with and without sutures,
respectively. Median follow-up was 3.2 years.
Results: Astigmatism did not differ significantly between F and
K - neither before (3.5 D/3.25 D median) nor after suture removal (5.0
D/4.0 D) (p>0.1). Before (1.53/1.18) and after suture removal (1.08/0.78)
SRI ranged significantly higher in F than in K (p </= 0.0001). Likewise,
SAI was higher in F than in K before (1.25/0.72) and after suture removal
(0.91/0.58) (p </= 0.0001). Visual acuity in K exceeded that in F before
(0.50/0.60) and even more after suture removal (0.50/0.70) (p<0.0001).
SEQ in K was significantly more myopic than in F before and after suture
removal (p<0.02).
Conclusions: Visual outcome after PK is markedly better in K than
in F. Since the amount of astigmatism is comparable, these differences
may mainly result from the more irregular topography of the graft in F
with smaller graft diameter. However, the impact of a decreased tear film
stability in older patients with F can not be ruled out at this time.