Corneal topographic results after eccentric, biconvex penetrating keratoplasty

To study the surgical outcomes and postoperative corneal topographies in 5 patients who had eccentric, biconvex penetrating keratoplasty (PKP) for peripheral corneal disorders whose extent did not allow the use of round grafts without involving the center of the cornea.

1st Department of Ophthalmology, Semmelweis University, Medical School, Budapest, Hungary.

Eccentric, biconvex PKP that spared the optical axis of the cornea was performed in 5 eyes. Indications for surgery were perforated peripheral ulcerative keratitis (n = 3), extensive infiltrated peripheral ulcerative keratitis with impending perforation (n = 1), and ulcerated corneal degeneration caused by an intracameral foreign body for 9 years (n = 1). Computer-assisted corneal topography was performed postoperatively. The follow-up ranged from 8 to 27 months.

All grafts were tectonically effective. Postoperative corneal topography showed normal central corneal regularity in 4 cases (1 case, normal pattern with surface regularity index [SRI] and surface asymmetry index [SAI] within the normal range; 3 cases, normal surface regularity within the central area of the cornea but moderate or high central corneal asymmetry). One eye had irregular astigmatism with a high SRI and SAI. In the first 4 cases, the best spectacle-corrected visual acuity was 0.8 (20/25) or better.

The results show that eccentric, biconvex PKP sparing the central cornea may be an option in some eyes with perforated peripheral corneal disorders. Postoperative visual acuity may be good as the procedure may result in a regular central anterior corneal surface.