Background: The results of penetrating keratoplasty in two centres for cornea transplantation were investigated with regard to the following parameters: the t rephine system used, the origin of the donor cornea, the i...
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Background: The results of penetrating keratoplasty in two centres for cornea transplantation were investigated with regard to the following parameters: the t rephine system used, the origin of the donor cornea, the influence on the postop erative astigmatism and other aspects. Patients and Methods: The retrospective c linical investigation reports about the results of 186 patients with penetrating keratoplasty from the University Eye Hospital of Halle and 204 patients from th e Eye Clinic of the Helios hospital Aue. Results: Three trephine systems have be en used: the Hessburg-barron trephine, the guided trephine system (GTS) and the Asmotom device. There were no significant differences between them concerning v isual acuity after 12 months postoperatively. The results were highly significan tly better (P=0.003 Halle; P=0.001 Aue) when using larger diameters of the treph ine (7.5 mm and 8.0 mm). The origin of the donor cornea (“fresh”cornea from a deceased subject or organ cultivated cornea from a cornea bank) had no influence on visual outcome after twelve months (P > 0.8). There were less wound dehiscen ces using the double running suture in comparison with other techniques (P=0.05) . The removal of suturing material was not effective in reducing postoperative a stigmatism (P > 0.11). There was no increase in astigmatism when leaving the sut ures in situ (P > 0.25). Conclusions: Generally, each of the three trephine syst ems can be recommended for clinical use. The trephination should be done with tr ephine diameters of 7.5 mm or 8.0 mm. A timely operation guarantees better visua l acuity at one year postoperatively.
Objective To compare the therapeutic outcomes after deep lamellar keratoplasty (DLK) and penetrating keratoplasty (PK)in patients with keratoconus. Design Ret rospective case-control study. Participants We reviewed th...
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Objective To compare the therapeutic outcomes after deep lamellar keratoplasty (DLK) and penetrating keratoplasty (PK)in patients with keratoconus. Design Ret rospective case-control study. Participants We reviewed the clinical notes of 4 7 patients diagnosed clinically with keratoconus who had received DLK (26 eyes o f 25 patients) or PK (25 eyes of 22 patients) at Moor-fields Eye Hospital or th e Royal Shrewsbury Hospital between 1994 and 2001. The patients in the 2 groups were matched for severity of their keratoconus by preoperative visual acuity. Me thods Deep lamellar keratoplasty was performed with the Melles technique in 7 ey es and the technique described by Sugita and Kondo in 19 eyes. Penetrating kerat oplasty was performed with a standard technique using a Hessburg-barron trephin e. A single continuous 16-bite 10-0 nylon suture was placed and adjusted in bo th groups. Main outcome measures Best-corrected visual acuity (BCVA), refractiv e results, surgical techniques for DLK, and complication rates were analyzed. Re sults The 25 patients with keratoconus who underwent DLK had a mean age of 32.6 years and a median follow-up of 28 months. The mean age of the 22 patients who underwent PK for keratoconus was 34 years. This group was followed up for a medi an time of 55 months. The median final BCVA of patients in the DLK group was 6/9 and in the PK group 6/6 (no statistical significance). The median result for th e final spherical equivalent power in both groups was mild myopia, although the DLK group had more myopia, and the median astigmatism was less than 5.00 d iopters cylinder for both groups. Complication rates were similar for DLK and PK , although the nature of the complications varied. Conclusions Penetrating kerat oplasty is no longer an automatic choice for the surgical treatment for keratoco nus; DLK seems to be a safe alternative. Best-corrected visual acuity, refracti ve results, and complication rates are similar after DLK and PK. Deep lamellar
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