[Prognosis of keratoplasty in hereditary stromal dystrophies]

Comparative and longterm observations of corneal transplants in hereditary stromal dystrophies are rare.

54 perforating keratoplasties in 37 patients were performed in our clinic within 22 years. In all cases we carried out a retrospective study paying special attention to changes in visual acuity and recurrence of the disease. In the course of time some patients were lost or had to be excluded from our study. 47 eyes were left after more than two years, 38 eyes after more than 4 years and 18 eyes after more then 10 years.

Lattice dystrophy (21 eyes) and granular dystrophy (19 eyes) were more frequent than macular dystrophy (14 eyes). By the time the first eye was operated patients with macular dystrophy were approximately 10 years younger than patients with lattice or granular dystrophy. The preoperative visual acuity (0.15) was about the same in all three types of corneal stromal dystrophy. In macular dystrophy visual acuity remained almost constantly at 0.7 after surgery, whereas the visual acuity in lattice and granular dystrophy decreased gradually to 0.4. The deterioration of visual acuity was mainly due to recurrence of the disease in the graft. In macular dystrophy we observed 2 late recurrences after 14 years only. 7 recurrences in lattice dystrophy and 14 recurrences in granular dystrophy were noted within 3 to 8 years after transplantation. The onset of recurrences were seen earlier in patients younger than 45 years.

With regard to longterm results of visual acuity and graft-clarity macular dystrophy has a better prognosis than lattice and granular dystrophy. The onset of recurrences seems to be dependent on the patients age.