Penetrating keratoplasty in keratoconic eyes with prior radial keratotomy

The aim of this study is to evaluate the long-term therapeutic outcomes and potential intraoperative and postoperative complications of penetrating keratoplasty in keratoconic eyes with prior radial keratotomy.

In this retrospective study, we reviewed the clinical data for keratoconic eyes with prior radial keratotomy that underwent penetrating keratoplasty between 1995 and 2007.

Data were obtained from 16 patients (24 eyes). The mean time interval between radial keratotomy and penetrating keratoplasty was 50.2 months. The mean postoperative follow-up period was 33.7 months. The mean best spectacle-corrected visual acuity (BSCVA) improved from 20/342 (range: 20/1200 to 20/100) preoperatively to 20/32 (range: 20/100 to 20/16) at the last control visit (p<0.05). None of the eyes had a preoperative BSCVA better than 20/100, while 91.7% of the eyes had a BSCVA of 20/40 or better at the end of the follow-up period. The mean keratometric astigmatism was 8.03 diopters preoperatively as compared with 3.63 diopters at the end of the follow-up period. There were no intraoperative complications. Six eyes (25.0%) experienced at least one episode of immunologic graft rejection during the follow-up period. One eye required a new corneal transplantation because of graft failure.

Penetrating keratoplasty for treating keratoconic eyes with previous radial keratotomy provides good visual outcomes and low graft rejection rates. We did not encounter any intraoperative difficulty related to the previous radial keratotomy. However, more caution during the keratoplasty is needed to overcome possible incision-related complications that may negatively affect the surgery and its outcome.