Faculty Bibliography

Seven patients underwent penetrating keratoplasty after epikeratophakia for keratoconus. All seven patients achieved clear grafts and 20/40 or better best corrected visual acuity after penetrating keratoplasty. Three of the seven patients had one or more episodes of rejection after penetrating keratoplasty; all were treated successfully. No grafts were lost. The results in terms of graft clarity and visual acuity are comparable with those in patients undergoing penetrating keratoplasty for keratoconus with no previous ocular surgery. Whether the relatively high rate of rejection episodes (three [43%]) seen in this small number of patients indicates some relationship between previous epikeratophakia and subsequent rejection after penetrating keratoplasty remains to be seen

A nationwide study of epikeratophakia for aphakia in older children was conducted from March 1984 to March 1986. Sixty-three patients, 8 to 18 years of age, underwent this procedure in 65 eyes. Twenty-eight patients had congenital cataracts and 35 had traumatic cataracts. Fifty-one of the 65 eyes were aphakic at the time of surgery (secondary procedures). All surgeries were successful; no tissue lenses were lost or removed. Postoperatively, 73% of the patients were within 3 diopters (D) of emmetropia. The patients with congenital cataracts gained an average of one Snellen line of best-corrected visual acuity; patients with traumatic cataracts lost an average of one Snellen line of best-corrected visual acuity. In older pediatric patients, epikeratophakia appears to be a safe and effective procedure for the correction of aphakia

The Prospective Evaluation of Radial Keratotomy (PERK) study is a nine-center clinical trial of a standardized technique of radial keratotomy in 435 patients who had simple myopia with a preoperative refractive error between -2.00 and -8.00 diopters (D). The authors report results for one eye of each patient. The surgical technique consisted of eight incisions using a diamond micrometer knife with the blade length determined by intraoperative ultrasonic pachymetry and the diameter of the central clear zone determined by the preoperative refractive error. At 3 years after surgery, 58% of eyes had refractive error within 1.00 D of emmetropia; 26% were undercorrected and 16% were overcorrected by more than 1.00 D. Uncorrected visual acuity was 20/40 or better in 76% of eyes. The operation was more effective in eyes with a preoperative refractive error between -2.00 and -4.37 D. Between 1 and 3 years after surgery, the refractive error changed by 1.00 D or more in 12% of eyes, indicating a lack of stability in some eyes. In the 435 eyes, there was a small number of complications including six eyes that lost two or three lines of best-corrected acuity, 16 that experienced vascularization of the incisions, 2 that had delayed bacterial keratitis, and 4 that had recurrent epithelial erosions

Our computer-based corneal topography analysis system was used to study the keratoscope photographs (keratograms) from two patients with classic pellucid marginal degeneration and a third patient with no inferior corneal thinning, whose keratoscope mire pattern was suggestive of the condition. All three patients showed marked flattening of the central cornea along a vertical axis and marked steepening of the inferior corneal periphery, which also extended into mid-peripheral inferior oblique corneal meridians. The mid-peripheral cornea gradually decreased in power above the inferior oblique meridians

A patient experienced marked visual distortion following myopic keratomileusis, despite the presence of a clear graft and an apparently smooth corneal surface. A color coded topographic map of corneal surface power generated by computer analysis of a keratoscope photograph of the operated eye identified a degree of irregular astigmatism and asphericity not readily apparent from simple visual inspection of the keratoscope photograph. Contour map graphics display of corneal surface power is a useful clinical tool in the evaluation of visual distortion complications following myopic keratomileusis

Pseudophakic bullous keratopathy is now the most common reason for penetrating keratoplasty. In previous reports, the type of intraocular lens (IOL) most frequently encountered in these eyes was the iris plane IOL. The authors reviewed 27 cases of IOL removal during penetrating keratoplasty. Lenses were removed if they were dislocated or associated with iritis, recurrent hyphema, glaucoma, or persistent cystoid macular edema. The IOL encountered most often was the anterior chamber lens (in 22 eyes); closed thin loop, semiflexible or flexible anterior chamber lenses accounted for 19 of these. Iris plane lenses were removed from five eyes. No posterior chamber lenses were removed. Clear grafts were obtained in 24 of 27 cases (89%); visual acuity improved or remained the same in 24 cases, to 20/60 in 11 cases. The most common causes of poor postoperative vision were retinal disease (6/27 cases) and glaucoma (6/27 cases). The association between anterior chamber lenses and pseudophakic bullous keratopathy is probably the result of both the increase in use of these lenses and the documented propensity of the closed loop semiflexible anterior chamber lenses to cause complications