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First Author: I.Almeida PORTUGAL
Co Author(s): M. Ruão C. Ferreira S. Gonçalves J. Salgado-Borges
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To describe two approaches to reduce post-penetrating keratoplasty (PK) astigmatism in keratoconus patients. The first group underwent optical correction with contact lenses (CL) and the second group was submitted to the implantation of intrastromal corneal ring segments (ICRS). The authors present their clinical and topographic evolution.
Visual acuity (VA) after successful PK depends mainly on the clarity of the graft and the refractive error, particularly the astigmatism. In fact, pos-keratoplasty astigmatism is one of the major problems that can compromise the patients visual rehabilitation after surgery; Various studies have shown that the number of grafts with ?3D of astigmatism 2 years after transplantation ranges between 27% and 34%, depending on the indication for corneal grafting. To achieve visual improvement and binocularity there are a variety of approaches to reduce postoperative that include spectacles, contact lenses and surgical procedures.
Clinical case reports
The first group includes three patients treated with CL special for keratoconus and irregular cornea. They were submitted to KP 5, 4 and 2,5 years ago. After sutures removal, their non corrected VA was 2/10, 4/10 and 3/10 and their BCVA was 3/10 (-1,0 -4,0x80Ḟ), 9/10 (+3,0 -4,0x40Ḟ) and 6/10 (-0,75 -3,0x70Ḟ) respectively. They were treated with CL and they present now BCVA of 9/10 (-2,50 -1,75x80Ḟ), 10/10 (+2,50 +2,25x110Ḟ) and 8/10 (-4,50 -4,0x70Ḟ). The second group include also three patients submitted to KP and after that treated with implantation of ICRS. One patient presented with uncorrected VA <2/10 and BCVA of 2/10 (-2,50 +0,50X20Ḟ) after KP. He was submitted to implantation of ICRS 5 years ago and now his BCVA is 8/10 (-0,50x40Ḟ). The second patient presented with uncorrected VA <1/10 and BCVA of 1/10 (+5,0x60Ḟ) 7 years after KP; he was submitted to implantation of ICRS and now his BCVA is 5/10 (-0,50-5,0x120Ḟ). The last patient presented uncorrected VA <1/10 and BCVA of 5/10 with -6,50x45Ḟ and was submitted to implantation of ICRS this week, 5 years after KP.
Astigmatism is the main reason for unsatisfactory visual results after corneal transplantation despite a clear corneal graft. Visual rehabilitation remains challenging and none of the multiple corrective options appear as a perfect option. So astigmatism management should be guided on patients needs and refraction, keratometry and corneal topography. We present a pool of patients with two different approaches with good functional results.