Corneal transplant for keratoconus: results in early and late disease

To evaluate the results and complications rates associated with corneal transplantation for keratoconus and assess the prospects of using penetrating keratoplasty at a much earlier stage.

Buzard Eye Institute, Las Vegas, Nevada, USA.

In this prospective clinical study, 104 eyes of 76 patients had corneal transplantation for keratoconus identified by corneal topography, keratometry, pachymetry, and/or retinoscopy. Sutures were removed at a mean of 15 months; mean follow-up was 42 months. All surgeries were performed by one surgeon using a torque-antitorque suture method. Eyes were grouped according to severity of the disease: early (n = 24); moderate (n = 47); high (n = 33). Preoperative keratometry was 40.00 to 49.00, 50.00 to 59.00, and 60.00 to 90.00 diopters (D), respectively. The criteria for corneal transplant were a best spectacle-corrected visual acuity of 20/40 or worse and keratoconus clearly identified by one of the above methods. Secondary procedures included repair of wound dehiscence (33 eyes, 31%), relaxing incisions (33 eyes, 31%), wedge resections (5 eyes, 5%), and automated lamellar keratoplasty (4 eyes, 4%).

Mean postoperative uncorrected visual acuity at last follow-up was 0.43 +/- 0.3 (20/50), with 46 eyes (44%) achieving 20/40 or better. Mean best corrected visual acuity (BCVA) at last follow-up was 0.83 +/- 0.2 (20/25). Sixty eyes (58%) achieved 20/40 or better BCVA at 1 month and 92 eyes (88%), at 3 months. At last follow-up, mean average keratometric astigmatism was 3.10 +/- 1.70 D, mean keratometry was 43.30 +/- 2.20 D, and mean spherical equivalent was -1.70 +/- 3.00 D. Complications included 21 graft rejections (20%); 19 were successfully treated with topical and oral steroids. No expulsive hemorrhage or endophthalmitis occurred.

The risk-benefit for corneal transplantation has been significantly altered by improved surgical and postoperative techniques. The improved results, low complication rate, and postoperative enhancement management indicate that corneal transplantation is a viable option early in the clinical course of keratoconus.