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Changes of Refraction, Keratometry and Axial Length after Keratoplasty for Keratoconus using the Guided Trephine System (GTS®)
Italon C., Pieh S., Hanselmayer G., Kahraman G., Skorpik C., Dejaco-Ruhswurm I.,
Universitätsklinik für Augenheilkunde und Optometrie, Refraktive Ambulanz, AKH Wien (Wien)
Purpose: The purpose of this study was to examine the cause of increasing myopia after keratoplasty for keratoconus with the guided trephine system (GTSâ).
Method: 30 eyes after keratoplasty for keratoconus were examined. Preoperatively and 1, 3, 6, 12 and 24 months postoperatively subjective refraction was evaluated. Keratometry was calculated with a computerized videokeratoscope (TMS I). Axial length was measured by using applanation ultrasonography before surgery and 2 years after surgery. Anterior chamber depth, lens thickness and vitreous length were taken into consideration.
Results: The mean spherical equivalent was 2.22±3.47 D one month postoperatively and had a continuous myopic shift to -1.02±2.65 D two years postoperatively. This was associated with a significant increase in mean keratometric levels with the period from 41.72±2.96 D one month postoperatively to 43.77±2.29 D two years postoperatively (rs=-0.36, p=0.05). Overall, no significant changes of axial length were observed. However, vitreous length showed a small, but statistically significant increase. As expected, mean anterior chamber depth decreased significantly postoperatively (p<0.05).
Conclusions: The results of our study confirmed continuous myopic shift over time. Increasing myopia was associated with increasing keratometric values. Thus, the major cause of increasing myopia after keratoplasty in keratoconus cases seems to be continuing keratectasia. However, ongoing bulbus growth may contribute to continuing myopia in some patients.