Evaluación de la calidad de vida relacionada con la visión posterior a queratoplastia penetrante / Evaluation of the quality of life related to vision after penetrating keratoplasty

INTRODUCCIÓN: La donación y el trasplante de órganos y tejidos representan el avance terapéutico más importante de los tiempos actuales. La córnea es, por mucho, uno de los tejidos más trasplantados a nivel mundial gracias a los privilegios inmunológicos encontrados en este tejido, además de los avances en microcirugía, la existencia de bancos corneales, la preservación de córneas y la aplicación de terapia contra el rechazo. Sin embargo, muchos pacientes con trasplantes corneales exitosos (con córneas claras) experimentan mala visión en el periodo postoperatorio por astigmatismo irregular u otras complicaciones. OBJETIVO: Evaluar la calidad de vida relacionada con la visión en pacientes sometidos a queratoplastia penetrante. MATERIAL Y MÉTODOS: Estudio transversal-analítico que incluye pacientes con antecedente de queratoplastia penetrante, mayores de 18 años y al menos 6 meses de posquirúrgico. Los pacientes respondieron el Visual Function Questionnaire25 (VFQ-25) de la función visual, instrumento validado para su uso en español, y en el que a mayor puntación mejor calidad de vida. RESULTADOS: Se incluyeron 30 pacientes (20 hombres y 10 mujeres), con una media de edad de 61,2 ± 18,7 años. El tiempo de evolución posterior al trasplante fue de 17,7 ± 4 meses. La puntuación total en la calidad de vida fue de 74,9 ± 21,9, con significación estadística en la agudeza visual (p < 0,001) y en la presencia de enfermedades sistémicas (p = 0,018). No hubo significación estadística en el motivo de trasplante (p= 0,098) ni en la presencia de enfermedades oculares (p = 0,119). CONCLUSIÓN: Los resultados sugieren que la agudeza visual, así como la presencia de enfermedades sistémicas, tienen un impacto significativo en la calidad de vida

INTRODUCTION: Organ and tissue donation and transplantation represent the most important therapeutic advance of current times. The cornea is, by far, one of the most transplanted tissues worldwide due to the immune privilege of this tissue, as well as the advances in microsurgery, existence of cornea banks, preservation of corneas, and use of anti-rejection therapy. However, many patients with successful corneal transplants (with clear corneas) experience poor vision in the post-operative period due to irregular astigmatism, or other complications. OBJECTIVE: To evaluate the quality of life related to vision in patients undergoing penetrating keratoplasty. MATERIAL AND METHODS: A cross-analytical study including patients with a history of penetrating keratoplasty, over 18years of age, and at least 6months after surgery. The patients answered the Visual Function Questionnaire25 (VFQ-25) of visual function, a tool validated for use in Spanish, in which the higher the score, the better the quality of life. RESULTS: Thirty patients (20 men and 10 women), with a mean age of 61.2 ± 18.7 years, were included. The time of evolution after the transplant was 17.7 ± 4 months. The total quality of life score was 74.9 ± 21.9, with significance in visual acuity (P < .001), and the presence of systemic comorbidities (P = .018). There was no significance between the transplant reason (P = .098) or ocular comorbidities (P = .119). CONCLUSION: The results suggest that visual acuity, as well as the presence of systemic comorbidities, has a significant impact on quality of life

A new knotless technique for combined transscleral fixation of artificial iris, posterior chamber intraocular lens, and penetrating keratoplasty.

PURPOSE: To present a new surgical technique for treating corneal opacity and aniridia with aphakia and the results in a small consecutive case series. METHODS: A three-piece acrylic intraocular lens (IOL) was attached to a customized silicone iris prosthesis and fixed with three 10-0 polypropylene sutures in a knotless technique using Z-sutures after trephination of the recipient cornea. The medical records of all consecutive patients who had received a keratoplasty and an implantation of an artificial iris and IOL were reviewed. RESULTS: Five eyes of five patients were included in the analysis. The mean age of the patients was 46.2 years and the mean follow-up was 24.6 months. The mean best-corrected visual acuity improved from 1.36 logMAR before surgery to 0.78 logMAR after surgery during the follow-up. At the last follow-up visit, the artificial iris-IOL complex was well centered with good positioning in all cases. CONCLUSIONS: Management of post-traumatic aniridia combined with aphakia and corneal scars or graft failure by haptic fixation of a foldable IOL on an artificial iris combined with a simultaneous keratoplasty appears to be a promising approach, which allows to correct a complex lesion with a less traumatic and faster procedure.

Resultados visuales y sobrevida de injerto obtenidos en una población pediátrica sometida a queratoplastia / Visual outcomes and graft survival in pediatric patients underwent penetrating keratoplasty

Objetivo: Describir resultados visuales y complicaciones de una serie de casos de pacientes pediátricos a los que se les realizó queratoplastia penetrante en el Hospital de San José, en Bogotá, Colombia. Diseño: Estudio observacional descriptivo, retrospectivo, serie de casos. Método: Se evaluaron 14 ojos de 12 pacientes menores de 16 años a quienes se les realizó queratoplastia penetrante entre los años 1999-2014. Se hizo una revisión de la literatura sobre etiología, manejo quirúrgico, seguimiento y sobrevida de injerto. Resultados: De los 14 ojos estudiados 8 ojos (57,1%) tenían patología congénita con injerto claro en 6 ojos (75%) entre los 3 y 9 meses, 3 ojos (21,4%) tenían etiología traumática, de estos, todos los injertos permanecieron claros en un rango de 3 meses a 11 años y 3 ojos (21,4%) tenían leucomas, queratitis o inminencia de perforación, de estos el injerto permaneció claro entre los 3 y 18 meses. Se encontró una mejoría de visión en 8 de los ojos evaluados (57,1%). Las complicaciones encontradas en estos pacientes fueron: glaucoma en 5 ojos (35.7%), falla de injerto en 6 ojos (42.8%), rechazo endotelial en 7 ojos (50%) y desprendimiento de retina en 1 ojo (7.14%). Conclusión: En el estudio, la mejoría visual fue ligeramente menor a la reportada en la literatura. Las complicaciones presentadas fueron principalmente rechazo endotelial y falla de injerto, lo que difiere de la literatura donde la catarata es la principal complicación.

Purpose: To describe visual results and complications in a case series of paediatric patients who underwent penetrating keratoplasty at Hospital de San José in Bogotá, Colombia. Design: Observational, descriptive and retrospective study, series of cases. Method: 14 eyes of 12 patients under 16 years (2 months - 16 years) who underwent penetrating keratoplasty in Hospital de San Jose from 1999 to 2014 were evaluated. A literature review of etiology, surgical management, monitoring and graft survival of pediatric patients was done. Results: Of the 14 eyes studied, 8 eyes (57.1%) had congenital pathology with clear graft in six eyes between 3 and 9 months, 3 eyes (21.4%) had traumatic aetiology, of these, all graft s remained clear in a range of 3 months to 11 years and 3 eyes (21.4%) had leucoma, keratitis or impending perforation, of these, the graft remained clear between 3 and 18 months. An improvement in vision was found in eight of the evaluated eyes (57.1%). The complications found in these patients were: glaucoma in 5 eyes (35.7%), graft failure in 6 eyes (42.8%), endothelial rejection in 7 eyes (50%) and retinal detachment in 1 eye (7.14%). Conclusion: In our study, the visual improvement was slightly lower than that reported in the literature. The complications presented were mainly endothelial rejection and graft failure, which differs from the literature where cataract is the main complication.

Visual rehabilitation using mini-scleral contact lenses after penetrating keratoplasty.

PURPOSE:: To report the visual rehabilitation outcomes and complications of patients fitted with mini-scleral rigid gas-permeable (RGP) contact lenses (mini-SCLs) after penetrating keratoplasty. METHODS:: We retrospectively reviewed 27 eyes (21 patients) that were fitted with mini-SCLs between October 2013 and December 2014. We analyzed demographic data, previous corneal disorders, visual outcomes, interval from keratoplasty to contact lens fitting, topographic and specular microscope data, fitted contact lens parameters, and complications. The patients were divided into two groups according to the elapsed time since surgery: Group A, grafts with <10 years (n=14 eyes); and Group B, grafts with ≥10 years (n=13 eyes). RESULTS:: Lens use was discontinued in four eyes, and microbial keratitis developed in one eye during follow-up. No corneal graft rejection was observed. The mean interval between grafting and initial contact lens fitting was 10.6 ± 7.3 years (range: 1-29 years). The most frequent reason for keratoplasty was keratoconus (22 eyes, 81.4%). The mean contact lens-corrected visual acuity (CLCVA) was 0.09 ± 0.12 logMar (range: 0.50-0.00 logMar). The average topographic astigmatism, mean steepest keratometry (Kmax), and average cellularity on specular microscopy were 6.19 ± 3.49 diopters (D), 58.4 ± 7.8 D, and 1,231 ± 723 cells/mm2, respectively. CONCLUSIONS:: Mini-SCL use allowed successful visual rehabilitation after corneal keratoplasty, particularly in patients who required corrective lenses for low visual acuity and were unable to wear RGP contact lenses. Our results indicate that mini-scleral lenses may be an option for the treatment of corneal irregularities, such as those associated with keratoplasty.

Visual rehabilitation using mini-scleral contact lenses after penetrating keratoplasty / Reabilitação visual após transplante penetrante de córnea com lentes de contato mini-esclerais

ABSTRACT Purpose: To report the visual rehabilitation outcomes and complications of patients fitted with mini-scleral rigid gas-permeable (RGP) contact lenses (mini-SCLs) after penetrating keratoplasty. Methods: We retrospectively reviewed 27 eyes (21 patients) that were fitted with mini-SCLs between October 2013 and December 2014. We analyzed demographic data, previous corneal disorders, visual outcomes, interval from keratoplasty to contact lens fitting, topographic and specular microscope data, fitted contact lens parameters, and complications. The patients were divided into two groups according to the elapsed time since surgery: Group A, grafts with <10 years (n=14 eyes); and Group B, grafts with ≥10 years (n=13 eyes). Results: Lens use was discontinued in four eyes, and microbial keratitis developed in one eye during follow-up. No corneal graft rejection was observed. The mean interval between grafting and initial contact lens fitting was 10.6 ± 7.3 years (range: 1-29 years). The most frequent reason for keratoplasty was keratoconus (22 eyes, 81.4%). The mean contact lens-corrected visual acuity (CLCVA) was 0.09 ± 0.12 logMar (range: 0.50-0.00 logMar). The average topographic astigmatism, mean steepest keratometry (Kmax), and average cellularity on specular microscopy were 6.19 ± 3.49 diopters (D), 58.4 ± 7.8 D, and 1,231 ± 723 cells/mm2, respectively. Conclusions: Mini-SCL use allowed successful visual rehabilitation after corneal keratoplasty, particularly in patients who required corrective lenses for low visual acuity and were unable to wear RGP contact lenses. Our results indicate that mini-scleral lenses may be an option for the treatment of corneal irregularities, such as those associated with keratoplasty.

RESUMO Objetivos: Avaliar a reabilitação visual e complicações com o uso de lentes de contato rígidas gás-permeáveis mini-esclerais em pacientes submetidos ao transplante penetrante de córnea. Métodos: Estudo retrospectivo de 27 olhos (21 pacientes) adaptados com lentes de contato mini-esclerais entre outubro de 2013 e dezembro de 2014. Informações demográficas, doença corneana prévia, acuidade visual, tempo decorrido entre transplante e adaptação da lente, dados topográficos e de microscopia especular, parâmetros da lente de contato adaptada e complicações foram analisadas. Os pacientes foram divididos em dois grupos, levando em consideração o tempo decorrido do transplante de córnea: menos de 10 anos (Grupo A, n=14 olhos) e mais de 10 anos (Grupo B, n=13 olhos). Resultados: Quatro olhos desistiram do uso da lente de contato e 1 paciente apresentou quadro de ceratite infecciosa durante o período de acompanhamento. Não ocorreu episódio de rejeição de botão corneano transplantado durante o período avaliado. O tempo médio entre o transplante e a adaptação da lente de contato foi de 10,6 ± 7,3 anos (variação de 1 a 29 anos) e a causa mais frequente de ceratoplastia foi ceratocone (22 olhos, 81,4%). A acuidade visual média corrigida com lente de contato foi de 0,09 ± 0,12 logMar (variação de 0,50 a 0.00 logMar). O astigmatismo topográfico médio foi de 6,19 ± 3,49 dioptrias (D), a ceratometria média mais curva (Kmax) foi 58,4 ± 7,8 D e a celularidade média na microscopia especular foi 1.231 ± 723 células/mm2. Conclusões: Este estudo retrospectivo mostra o sucesso da adaptação de lentes de contato mini-esclerais na reabilitação visual após o transplante de córnea, especialmente em pacientes com baixa acuidade visual com óculos e intolerância ao uso de lentes de contato rígidas gás-permeáveis. Nossos resultados demonstram que as lentes de contato mini-esclerais são um opção para córneas com irregularidades corneanas, assim como aquelas após o transplante de córnea.

Visual Rehabilitation After Penetrating Keratoplasty.

OBJECTIVES: Here, our aim was to report our treatment strategies and their results performed for visual rehabilitation after penetrating keratoplasty. MATERIALS AND METHODS: The medical records of 98 patients (54 male/44 female), with results from 104 eyes, who underwent penetrating keratoplasty between January 2013 and January 2015 at the Baskent University Faculty of Medicine, Department of Ophthalmology were reviewed. Patient age, indication for penetrating keratoplasty, interventions performed for visual rehabilitation, follow-up duration, topographic and refractive astigmatism at the end of follow-up, and final best corrected visual acuity results were recorded. RESULTS: Mean age of patients was 54 ± 23 years. Indications for penetrating keratoplasty included keratoconus, Fuchs endothelial dystrophy, pseudophakic bullous keratopathy, and corneal scarring. The mean duration of follow-up was 23 ± 11.5 months. Topography-guided suture adjustment and selective suture removal were performed 2 to 6 weeks and after 3 months in eyes with more than 3 diopters of corneal astigmatism in patients who had continuous and interrupted sutures. Spectacle correction was administered for 86 eyes (83%), and contact lenses including rigid gas-permeable and scleral lenses were fitted in 18 eyes (17%) in patients who were unsatisfied with spectacle correction. Relaxing corneal incisions were performed in 23 eyes (22%), and toric intraocular lens implantations were performed in 34 eyes (33%) with cataracts. The mean topographic and absolute refractive astigmatism at the end of follow-up was 3.4 ± 2.6 and 3.6 ± 1.9 diopters. CONCLUSIONS: Topography-guided suture adjustment and selective suture removal are effective for minimizing early postoperative astigmatism. If significant astigmatism remains after suture removal, which cannot be corrected by optical means, then further surgical procedures including relaxing incisions and toric intraocular lens implantation can be performed.

Queratoplastia lamelar predescemética para el tratamiento del queratocono / Predescemetic lamellar keratoplasty for treatment of keratoconus

Objetivo: describir los resultados de la queratoplastia lamelar profunda en el tratamiento quirúrgico del queratocono en el Servicio de Córnea del Instituto Cubano de Oftalmología Ramón Pando Ferrer.Métodos: se realizó un estudio descriptivo prospectivo en 7 ojos con queratocono operados de queratoplastia lamelar profunda. Se analizaron las variables edad, sexo, grado de queratocono, agudeza visual preoperatoria y posoperatoria, astigmatismo posquirúrgico, paquimetría y queratometría topográfica a la semana, al mes y a los tres meses de la intervención. La información se procesó a través de frecuencias absolutas, relativas, medias y desviación estándar. Resultados: en el sexo masculino, el 42,9 por ciento tenía entre 18 y 39 años de edad al igual que el grupo de 40-50 años en el sexo femenino. El 57,2 por ciento de los casos presentó queratocono avanzado. En el posoperatorio se encontró que el 71,4 por ciento de los casos poseía una agudeza visual corregida entre 0,1-0,3 y 5-10 dioptrías de astigmatismo posquirúrgico; la paquimetría fue superior a 560 µm en el 85,6 por ciento; la queratometría promedio en el meridiano más fuerte fue de 47,77 y en el meridiano más débil, de 40,01. Conclusiones: la queratoplastia lamelar predescemética es una técnica quirúrgica que ofrece ventajas superiores en relación con las queratoplastias penetrantes(AU)

Objective: to describe the results of deep lamellar keratoplasty in the surgical treatment of keratoconus in the Corneal Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology.Methods: a prospective descriptive study of 7 eyes with moderate keratoconus who underwent predescemetic lamellar keratoplasty. The universe consisted of 7 eyes fom patients who met the criteria for deep lamellar keratoplasty surgery. The variables age, sex, degree of keratoconus, pre-and postoperative visual acuity, postoperative astigmatism, topographic keratometry and pachymetry after a week, a month and three months of the surgery. Data were analyzed by using absolute, relative, mean frequencies and standard deviations. Results: the 18-36 year age group in males represented 42,9 percent as the 40-50 years-old group in females. In the studied group, 57,2 percent of patients had advanced keratoconus. On the third postoperative month, 71,4 percent of patients had visual acuity ranging 0,1 to 0,3 and 5-10 postsurgical astigmatism diopters. Pachymetry observed in 85,6 percent of patients was higher than 560 um. The average keratometric value in the strongest meridian was 59,43 preoperatively and 47,77 postoperatively. In the weakest meridian, average keratometry was 50,28 and postoperative average amounted to 40,01. Conclusions: predescemetic lamellar keratoplasty is a surgical technique providing greater advantages if compared to penetrating keratoplasty(AU)

Queratoplastia lamelar predescemética para el tratamiento del queratocono / Predescemetic lamellar keratoplasty for treatment of keratoconus

OBJETIVO: describir los resultados de la queratoplastia lamelar profunda en el tratamiento quirúrgico del queratocono en el Servicio de Córnea del Instituto Cubano de Oftalmología "Ramón Pando Ferrer". MÉTODOS: se realizó un estudio descriptivo prospectivo en 7 ojos con queratocono operados de queratoplastia lamelar profunda. Se analizaron las variables edad, sexo, grado de queratocono, agudeza visual preoperatoria y posoperatoria, astigmatismo posquirúrgico, paquimetría y queratometría topográfica a la semana, al mes y a los tres meses de la intervención. La información se procesó a través de frecuencias absolutas, relativas, medias y desviación estándar. RESULTADOS: en el sexo masculino, el 42,9 % tenía entre 18 y 39 años de edad al igual que el grupo de 40-50 años en el sexo femenino. El 57,2 % de los casos presentó queratocono avanzado. En el posoperatorio se encontró que el 71,4 % de los casos poseía una agudeza visual corregida entre 0,1-0,3 y 5-10 dioptrías de astigmatismo posquirúrgico; la paquimetría fue superior a 560 µm en el 85,6 %; la queratometría promedio en el meridiano más fuerte fue de 47,77 y en el meridiano más débil, de 40,01. CONCLUSIONES: la queratoplastia lamelar predescemética es una técnica quirúrgica que ofrece ventajas superiores en relación con las queratoplastias penetrantes.

OBJECTIVE: to describe the results of deep lamellar keratoplasty in the surgical treatment of keratoconus in the Corneal Service of "Ramón Pando Ferrer" Cuban Institute of Ophthalmology. METHODS: a prospective descriptive study of 7 eyes with moderate keratoconus who underwent predescemetic lamellar keratoplasty. The universe consisted of 7 eyes fom patients who met the criteria for deep lamellar keratoplasty surgery. The variables age, sex, degree of keratoconus, pre-and postoperative visual acuity, postoperative astigmatism, topographic keratometry and pachymetry after a week, a month and three months of the surgery. Data were analyzed by using absolute, relative, mean frequencies and standard deviations. RESULTS: the 18-36 year age group in males represented 42,9 % as the 40-50 years-old group in females. In the studied group, 57,2 % of patients had advanced keratoconus. On the third postoperative month, 71,4 % of patients had visual acuity ranging 0,1 to 0,3 and 5-10 postsurgical astigmatism diopters. Pachymetry observed in 85,6 % of patients was higher than 560 um. The average keratometric value in the strongest meridian was 59,43 preoperatively and 47,77 postoperatively. In the weakest meridian, average keratometry was 50,28 and postoperative average amounted to 40,01. CONCLUSIONS: predescemetic lamellar keratoplasty is a surgical technique providing greater advantages if compared to penetrating keratoplasty.

Defining success in infant penetrating keratoplasty for developmental corneal opacities.

BACKGROUND AND PURPOSE: Neonatal corneal opacities (NCO) are one of the common causes of visual impairment in infants. We present the two infants with penetrating keratoplasty (PKP) for unilateral NCO with different visual and graft outcomes, and illustrate the importance of timing of surgery, importance of visual rehabilitation, and the lack of necessity of a clear graft to achieve reasonable visual function in infants with NCO. PATIENTS AND METHODS: Two infants with unilateral NCO (Peters anomaly) underwent PKP at age of 5.5 weeks (Case One) and 16 weeks (Case Two). Postoperative optical correction, amblyopia therapy, visual and graft outcomes were recorded. RESULTS: At the last follow-up (9.5 years in both the cases), Case One achieved a best-corrected visual acuity (BCVA) of 20/80 with -22 D of contact lens. The graft had a small clear zone centrally but otherwise was opacified to some extent. Case Two achieved a BCVA of 20/125 at 30 cms eccentrically with a clear graft. Case Two was uncooperative for amblyopia therapy and optical treatment. CONCLUSION: For a successful visual outcome in NCO, early PKP, aggressive amblyopia therapy, optical correction, and commitment from the parents for longterm follow-up and demanding treatment are required.

Scleral contact lenses for visual rehabilitation after penetrating keratoplasty: long term outcomes.

PURPOSE: To evaluate the success rate of highly gas permeable scleral contact lenses (SCL) for visual rehabilitation after penetrating keratoplasty (PK), over a period of up to 9 years. METHODS: A total database of 31 consecutive patient fitted with SCL between January 2004 and December 2009 was retrospectively reviewed. Demographic data, etiology prior to lens fitting, visual outcomes, follow up time and complications were analyzed. RESULTS: All eyes were fitted due to inadequate spectacle-corrected vision after successful penetrating keratoplasty or failure of other contact lens modalities. Out of 31 patients fitted, 28 (33 eyes) continue to wear SCL for periods between 0.5 and 8.8 years. The mean duration of follow-up after contact lens fitting was 5.2 ± 2.2 years. The mean age of corneal graft was 17.6 ± 11.4 years (range 4.3-42), and the mean interval between PK and initial contact lens fitting was 12.2 ± 10.7 years (range 0.7-36.0). The average steepest keratometry of our cohort was 55.0 ± 7.5 diopter (D) and the refractive astigmatism was 8.0 ± 4.4 D. The mean contact lens corrected visual acuity (BCVAcl) was 0.78 ± 0.25 (range 0.3-1.2). Twenty-three (82%) patients achieved a functional vision of 0.5 or more. During the studied period, ten (30.0%) eyes presented at least one graft rejection episode and two eyes (6%) had an episode of microbial keratitis. Corneal transplants of 20 years or more show a higher rate of refits due to ectasia recurrence. CONCLUSIONS: Scleral lenses should be considered as lens of choice in eyes with complex corneal geometry, as besides visual rehabilitation, their use may delay or prevent further surgical involvement.

Contact lenses and special back surface design after penetrating keratoplasty to improve contact lens fit and visual outcome.

AIMS: To describe the fitting of patients with high or irregular astigmatism following penetrating keratoplasty with contact lenses and to answer the question whether or not contact lenses with special back surface design can improve visual acuity in complex cases after penetrating keratoplasty. METHODS: 28 eyes were included. They were fitted with contact lenses with a special back surface that was designed for optical rehabilitation after penetrating keratoplasty. Four different types of these lenses (tricurve, keratoconus, reverse, oblong) were used selectively depending on abnormal eccentricity determined by videokeratoscope. The patients were followed up for an average period of 15.5 months. Lens tolerance and corrected visual acuity were evaluated and compared with that corrected with spectacles. RESULTS: The visual acuity was significantly improved in nearly all eyes with an average increase of 3.6 lines (maximal nine lines) accompanied by good contact lens tolerance and satisfactory contact lens fit. No noticeable complications were observed. CONCLUSION: Contact lenses with special back surface design can improve visual results and lens tolerance, and minimise problems in contact lens fitting. This is in favour of contact lenses as an alternative to surgical procedures for correction of high or irregular astigmatism after penetrating keratoplasty. This procedure is recommended especially in cases of patients who decline further operative interventions.

[The use of intracorneal rings in penetrating keratoplasty]. / Zum Einsatz von Nahtspannringen bei perforierenden Keratoplastiken.

BACKGROUND: The visual rehabilitation after penetrating keratoplasty (PKP) is affected by postoperative corneal astigmatism. Up to now studies were focused on different trephine systems as well as the suture techniques. A new option for reducing postoperative corneal astigmatism could be the implantation of an intracorneal ring. PATIENTS AND METHODS: Over a period of 2 years we implanted in 20 patients, who were suffering from keratoconus, Fuchs' dystrophy or bullous keratopathy, an 8-mm cobalt-molybdenum-titanium intracorneal ring in a prospective clinical trial. We used the guided trephine system (GTS) for preparation and a 10-0 nylon double running suture. The mean follow-up period was 16.2 months. A control group of 20 additional patients who underwent PKP was randomized. Topographic astigmatism as well as the spherical equivalent was evaluated after 1, 3, 6 and 12 months, respectively. RESULTS: Although a lower topographic astigmatism in the intracorneal ring group was reached 12 months postoperatively (3.0 dptr., SD 1.2 versus 4.0 dptr., SD 1.8) no statistical significance was found. The spherical equivalent in that group was lower during the complete evaluation period with a hyperopization in both groups as well. We did not see any immunological reactions caused by the ring. CONCLUSIONS: Whether the intracorneal ring could be a useful addition to PKP is not yet clear. Therefore more patients need to be enrolled and further studies established.

Post operative management of penetrating keratoplasty

Penetrating keratoplasty is a very delicate and precise procedure in ophthalmology. The preoperative, operative, and post operative care are all vitally important for the successful visual rehabilitation of the patient. This paper will only deal with the immediate post operative care with special attention to suture placement, epithelial defect, wound leakage, intraocular pressure and infections. The diagnosis and management of primary graft failure will also be discussed.(AU)

Transplante de córnea em crianças / Corneal transplantation in children

Foram analisadas cirurgias de transplante penetrante de córnea em crianças com idade de três meses a quatorze anos, realizadas no Instituto de Olhos de Goiânia nos últimos anos. Este estudo mostrou nítida diferença de resultados obtidos entre crianças na faixa etária até dez anos e nos maiores de dez. Ocorreram maiores complicaçöes no primeiro grupo, comprometendo o sucesso da intervençäo. A seleçäo dos casos foi obrigatória, näo levando à cirurgia daqueles sem perspectiva de resultados funcionais. Das vinte e seis cirurgias, quinze (57,69 por cento) obtiveram sucesso (transplante plenamente transparente). Destas quinze, treze (86,66 por cento) ficaram com acuidade visual de 20/20 a 20/40. Os outros dois (13,33 por cento) com 20/50 e 20/200. O acompanhamento destes pacientes foi de vinte meses a onze anos

Penetrating keratoplasty in the mentally retarded.

Penetrating keratoplasty is infrequently performed in the mentally retarded due to the high risk of serious post-operative complications, in particular wound rupture and severe inflammation of the graft. Graft survival is hindered by the patient's tendency for eye rubbing and possibly self-inflicted injury. Adequate nursing support is essential to ensure strict compliance with post-operative treatment. A retrospective study of corneal graft outcomes in mentally retarded patients was undertaken to assess graft survival, visual rehabilitation, post-operative complications and the influence on social behaviour. Six cases of penetrating keratoplasty performed in mentally retarded patients by one surgeon are presented. A continuous 10-0 nylon suture was employed in all cases. In 2 cases surgery was undertaken following perforation of the globe in patients with Down's syndrome. The grafts were retained in all cases and 2 patients achieved reasonably good acuity, although formal visual acuity assessment in these patients is limited. Penetrating keratoplasty in mentally retarded patients is a potentially hazardous procedure and patients require close supervision and good support care. This series demonstrates that relatively successful outcomes can be obtained in some mentally retarded patients.

Early visual rehabilitation following keratoplasty using a single continuous adjustable suture technique.

We measured postkeratoplasty visual acuity, refraction, retinoscopy, keratometry, and corneal topography in 105 patients, in 33 of whom an adjustable continuous technique had been used, and in 72 of whom a standard technique (in which the continuous suture was not adjusted) had been used. In the eyes in which the sutures were adjusted (within 6 weeks following surgery), acuity improved (preadjustment mean, 20/205; postadjustment mean, 20/100), and astigmatism decreased (preadjustment mean, 8.41 diopters; postadjustment mean, 2.22 D). Visual acuity and astigmatism in the control group were unchanged at the same point after surgery.