Results of Penetrating Keratoplasty after Epikeratophakia for Keratoconus in the Nationwide Study

Frantz, Jonathan M.; McDonald, Marguerite B.; Kaufman, Herbert E.

doi:10.1016/s0161-6420(89)32767-9

Cited by 11 publications

(6 citation statements)

References 26 publications

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“…In a previous paper (Høvding et al 1992), we suggested that due to functionally acceptable results and a low risk of serious complications, epikeratophakia should probably be the preferred surgical method in mentally retarded with keratoconus, if a poor postoperative patient compliance is anticipated. This is in accordance with recommendations from other authors (Frantz et al 1989). The present study did not show better graft survival in the non‐penetrating group, but the frequency of serious complications was significantly lower.…”

Section: Discussionsupporting

confidence: 93%

Corneal grafting for keratoconus in mentally retarded patients

Haugen

Høvding²,

Eide

et al. 2001

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: To compare the results of penetrating and non-penetrating corneal grafting procedures in mentally retarded keratoconus patients. Methods: In the years 1974-2000 41 mentally retarded patients with keratoconus (33 with Down syndrome) were operated with corneal grafting. Mean age at operation was 36.7∫10.8 years. Three different surgical procedures were used (no randomization): penetrating keratoplasty (nΩ16), lamellar keratoplasty (nΩ 5) and epikeratophakia (nΩ20). In a retrospective study, the non-penetrating procedures (lamellar keratoplasty and epikeratophakia) were compared to the penetrating keratoplasties with regard to graft survival and frequency of serious complications. Mean follow-up time of all grafting procedures was 80∫58 months. Results: All cases of serious complications (irreversible rejection, wound leakage or perforation) occurred in the penetrating keratoplasty group (pΩ0.0005). Older age at operation (pΩ0.011) adversely influenced the frequency of serious complications. Overall five-year survival was 74.9%. Graft survival was not related to surgical procedure, but rather to age at operation (poorer survival in older age, pΩ0.012) and degree of retardation (poorer survival in patients with more severe retardation, pΩ0.051). Conclusions: Because of the safety and low frequency of complications, epikeratophakia is recommended as the grafting procedure of choice in the majority of mentally retarded with keratoconus. In selected cases (good cooperation, age AE40 years, and a good peripheral corneal thickness) penetrating keratoplasty may be performed, which, if uncomplicated, often will give better functional/ optical results.

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Section: Discussionsupporting

confidence: 93%

Corneal grafting for keratoconus in mentally retarded patients

Haugen

Høvding²,

Eide

et al. 2001

Acta Ophthalmologica Scandinavica

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“…In an early report of patients undergoing penetrating keratoplasty after failed epikeratophakia there was an apparently increased rate of graft rejection of 43% (3 out of 7 cases) (Frantz et al 1988). However, a subsequent report of a larger series of patients showed a rejection rate of 13.6% (3 out of 22 cases) which is closer to the rejection rate expected in first time grafts (Frantz et al 1989).…”

supporting

confidence: 65%

HLA antigens in lyophilised corneal lenticules

Tabandeh

Morris

Rostron

et al. 1998

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: To investigate the presence of Human Leukocyte Antigens (HLA) in organ cultured corneas, in lyophilised epikeratophakia lenticules prepared by dry state lathing, and in lenticules subjected to prolonged rehydration in Balanced Salt Solution (BSS). Methods: Twelve lenticules and 3 organ cultured corneas were studied for the presence of HLA-ABC (class I), and HLA-DR, -DQ, and -DP (class II), antigens using the immunoperoxidase technique. Results: HLA-ABC antigens were detected in all lenticules. HLA-DR antigen was also detected in low concentrations in 6 out of 12 lenticules. HLA-DQ and -DP antigens were generally absent. Incubation in BSS for 24 and 48 hours did not change the expression of antigens. Conclusions: HLA-class I, and to some degree HLA-class II antigens, are present in the stroma of both organ cultured corneas, and in lyophilised lenticules. Incubation in BSS for up to 48 hours did not reduce the expression of antigens.

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“…26,27 For PK, the folds are usually preexisting in the grafts. 28 Descemet folds are also found after DALK in keratoconus eyes.…”

Section: Discussionmentioning

confidence: 99%

“…Posterior corneal folds have been known to impair visual acuity depending on their severity and location. 26,29,30 There have been no reports that described the detailed configuration of HSK-induced corneal folds or evaluated their long-term prognosis after DALK. Our results showed that the BCVA of the folds-on group was worse than that of the folds-off and no-folds groups in the first postoperative year.…”

Section: Discussionmentioning

confidence: 99%