Aktuelle Tagungsinformationen
News and Updates
Anmeldung zur Tagung
Registration
Hotelbuchung
Hotel Registration
Grußwort
Welcome address
Beteiligte Gesellschaften
Societies involved
Eröffnung des Kongresses
Opening Ceremony
Preise
Awards
Wissenschaftliches Programm
Scientific program
Posterpräsentationen
Poster Presentation
Kurse
Courses
Begleitende Veranstaltungen
Collateral Events
Rahmenprogramm
Social program
Jubiläumsparty
Jubilee Party
DOG Information
DOG Information
Allgemeine Informationen
General Information
Autorenindex
Index of Authors
Ausstellerliste
Exhibitors
Sponsoren
Sponsors
Teilnahmegebühren
Registration fees
Impressum
DOG Homepage
Outcome after Non-mechanical Penetrating Keratoplasty using the Excimer Laser - Prospective Study on the first 1000 Consecutive Elective Procedures
Seitz B., Langenbucher A., Nguyen N. X., Küchle M., Naumann G. O. H.,
Friedrich-Alexander-Universität, Augenklinik (Erlangen)
Purpose: Since 1998 nonmechanical corneal trephination (first patient 1989) has become the standard procedure in Erlangen for penetrating keratoplasty (PK) in avascular corneal diseases. The purpose of this study was to demonstrate the spectrum of diagnoses and surgical interventions, and the functional outcome of the first consecutive 1000 elective round PKs.
Method: In this prospective clinical cross-sectional study 362 eyes with keratoconus (median age 38 years (a)), 203 with Fuchs' dystrophy (67a), 178 with bullous keratopathy (73a), 94 with scars (65a), 38 with stromal dystrophies (45a), 25 with excessive post-PK astigmatism (54a), and 100 miscellaneous (56a) were included. Six microsurgeons performed 718x a PK only, 222x a triple procedure, and 60x an additional intervention on the lens implant (90% double running suture; 11% repeat PKs). Recipent (90% 7.0 to 8.0mm diameter) and donor trephination (0.1mm oversize, "Erlangen orientation teeth") were achieved by 193nm excimer laser from the epithelial side. In 79% sutures have been removed in part after 1,0a (median), and in 50% completely after 1,5a. Main outcome measures included keratometric astigmatism (KA), refractive cylinder (CYL), and best-corrected visual acuity (VA) before and after suture removal.
Results: After a median follow-up ranging from 1.2 to 2.0a immunological graft reactions happened in 4.7% of cases, in 1.8% a repeat graft became necessary. Before/after suture removal, median KA, CYL, VA were 3.0/3.0D, 2.5/2.5D, 0,7/0,7 in keratoconus; 3.5/3.0D, 2.0/1.5D, 0.5/0.5 in Fuchs' dystrophy; 3.3/3.0D, 0.0/0.0D, 0.3/0.3 in bullous keratopathy; 2.5/3.5D, 1.5/1.0D, 0.4/0.4 in scars; 2.5/2.0D, 2.0/1.5D, 0.7/0.7 in stromal dystrophies; 3.8/6.5D, 1.5/2.0D, 0.6/0.6 in excessive post-PK astigmatism; 2.3/3.2D, 1.0/1.5D, 0.4/0.5 in miscellaneous.
Conclusions: Using the laser trephine under standardized surgical conditions, a marked increase in astigmatism after suture removal is restricted to repeat PKs for excessive post-PK astigmatism. The most favorable visual acuity prognosis may be expected in keratoconus and stromal dystrophies, the most unfavorable in bullous keratopathies.