Thermokeratoplasty for Keratoconus: A More Than 30-Year Follow-Up Study.

PURPOSE: The aim of this study was to investigate the long-term outcomes of thermokeratoplasty (TKP) surgery in patients with keratoconus (KC). METHODS: We retrospectively reviewed our clinical database of 2949 patients with KC seen at the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan, between April 1979 and December 1991. Patients with KC who underwent TKP with a greater-than 30-year postoperative follow-up were included. The occurrence of adverse events including infectious keratitis, corneal perforation, corneal melting, bullous keratopathy, consistency of contact lenses (CL) wear at the final visit, and a history of corneal transplantation post-TKP was assessed. RESULTS: Forty-two patients (29 male and 13 female patients) with a mean age at initial visit of 23.4 years (range: 13.9-39.5 yrs) were included, and TKP was performed unilaterally in all cases. The mean follow-up period was 35.2 years (range: 30.1-41.6 yrs). As for adverse events/complications, no cases of infectious keratitis, corneal perforation, corneal melting, and/or BK were observed. However, 11 eyes received corneal transplants at an average of 24.9 years postoperatively because of the inability to wear CL continuously. At the last visit, 31 eyes were able to continue wearing CL without corneal transplantation, and the remaining 11 eyes were able to continue wearing contact lenses in all cases after corneal transplantation. CONCLUSIONS: TKP for KC resulted in relatively favorable surgical outcomes over the long-term postoperative period.

The Challenge of Contact Lens Visual Rehabilitation for Open Globe Injuries in Children Under 5 Years of Age.

PURPOSE: To investigate the clinical course of children younger than 5 years old who underwent rigid gas-permeable (RGP) contact lens (CL) wearing as visual rehabilitation of open globe injuries (OGIs) in Japan. METHODS: This retrospective case series involved six eyes of six children (four boys and two girls) with OGIs. The mean patient age at injury was 4.0±0.83 SD (range: 2.5-5 years), and the mean follow-up period was 42.9 months (range: 31.6-52.8 months). In each child, data regarding injury type, ocular surgery performed, outcomes of amblyopia management (including best-corrected visual acuity [BCVA] with RGP CL or spectacles), the RGP CL-wear training period, and rate of continuous RGP CL-wear were analyzed. RESULTS: Trauma type was penetrating injury (four eyes) and globe rupture (two eyes). All six cases showed lens penetration, and underwent corneal suture, lensectomy, and pars plana vitrectomy under general anesthesia. The mean RGP CL-wear training period was 3.5 months, and only one of the six cases discontinued RGP CL use. The mean BCVA with spectacles and with RGP CL was LogMAR: 1.52±0.41 (range 1.00-2.00) and 0.73±0.41 (range: 0.30-1.15), respectively. In all patients, except in one case in which strabismus developed, BCVA improved with RGP CL wear more than 0.2 logMAR compared with that with spectacles. CONCLUSION: Although the training period for RGP CL-wear is long in pediatric patients with OGIs, the treatment can be effective for refractive problems and for preventing the development of strabismus.

The association of HLA with young-onset keratoconus in Japan.

PURPOSE: To report the association of HLA antigens with keratoconus in Japanese patients. DESIGN: Observational consecutive case series. METHODS: In 90 consecutive Japanese keratoconus patients, HLA class I (HLA-A, -B, -C) and class II (HLA-DR, -DQ) were analyzed. RESULTS: Compared with control frequencies, based on mean gene frequencies for the Japanese population, higher frequencies of HLA-A26, B40, and DR9 antigens were found in patients whose conditions were diagnosed before 20 years of age (chi(2) = 6.45, P =.01; chi(2) = 6.78, P =.01; chi(2) =3.99, P =.05, respectively), but were not found in patients whose conditions were diagnosed later in life. Men were significantly younger at diagnosis than were women. No obvious relation was found between HLA antigens and other clinical data. CONCLUSION: HLA-A26, B40, and DR9, which were found relatively frequently in the ancient Japanese population, seem to be associated with keratoconus in younger individuals.