No abstract available.
Keratoplasty, Penetrating*

A large amount of corneal astigmatism after penetrating keratoplasty is a common problem. The purpose of this study was to find out which is the best suture method to minimize the postoperative corneal astigmatism. Among 35 eyes there were 7 eyes in interrupted suture group, 14 eyes in continuous suture group, and 14 eyes in combined suture group. In order to minimize postoperative astigmatism selective suture removal was done in interrupted suture group or combined suture group, and suture tension adjustment was made in continuous suture group. At postoperative 20 months the mean astigmastism was 5.97D in interrupted suture group, 3.66D in continuous suture group and 2.87D in combined suture group, respectively. There was no statistical significance. In spite of statistical insignificance, the astigmatism of continuous or combined suture group after penetrating keratoplasty was smaller than that of interrupted suture group after penetrating keratoplasty.
Astigmatism* ; Keratoplasty, Penetrating* ; Sutures*

We performed suture tension adjustment (STA) in 8 patients who had undergone penetrating keratoplasty with 10-0 nylon running suture closure. 3 to 8 weeks after the surgery, STA was done by loosening the suture tension at the steep meridian and tightening at the flat meridian, guided by automatic keratometery, keratoscopic finding and manifest refraction. Pre-STA astigmatism of 6.27 +/- 1.84 diopter(D) was changed to 1.94 +/- 1.40D immediately after the adjustment. Post-STA astigmatism regressed mostly within two weeks of adjustment, remaining stable thereafter: In one case, suture breakage occurred during adjustment, and resuturing was done using a new 10-0 nylon tied to the broken ends without serious sequela.
Astigmatism ; Humans ; Keratoplasty, Penetrating* ; Nylons ; Running* ; Sutures*

PURPOSE: To study a refractive change after suture removal and to evaluate some factors for this change in penetrating keratoplasty. METHODS: We studied 53 eyes of 47 patients who had undergone penetrating keratoplasty. Subjective refraction and best corrected visual acuity were measured in all eyes before and after the removal of sutures. We also classified the subject eyes based on suture removal time, degree of astigmatism before suture removal, recipient trephine size and compared the change of astigmatism within the groups. RESULTS: Suture removal decreased the astigmatism by an average of 0.81 diopter (D) (p=0.02) and increased the best corrected visual acuity by an average of 0.17 (p=0.005). These results show that corneal astigmatism tends to decrease more with early suture removal (p=0.010), higher degree of astigmatism before suture removal (p<0.05) and smaller size of recipient trephine (p=0.014). CONCLUSIONS: The removal of entire suture after penetrating keratoplasty decreases corneal astigmatism. Furthermore, the outcome is influenced by suture removal time, degree of astigmatism before suture removal, and recipient trephine size.
Astigmatism* ; Humans ; Keratoplasty, Penetrating* ; Sutures* ; Visual Acuity

PURPOSE: To describe femtosecond laser-assisted corneal biopsy and its use in assessing the causative organism in a case of fungal keratitis that occurred 8 months after penetrating keratoplasty. CASE SUMMARY: A 27-year-old man who had undergone penetrating keratoplasty 8 months prior showed atypical diffuse corneal haze and erosion. Diagnostic corneal biopsy using a femtosecond laser was performed because of repeated negative test results for an infectious organism and a lack of improvement, despite steroid and empirical antibiotic therapy. A corneal flap 200 micrometer in depth and 3 mm in diameter was obtained. The biopsy showed pseudohyphae, which led to a diagnosis of Candidal keratitis. No complications occurred during the procedure. CONCLUSIONS: Femtosecond laser-assisted corneal biopsy enabled identification of the infectious pathogen. This technique is easy, safe, and rapid, and it yields a biopsy specimen with a uniform depth and precise size. Femtosecond laser-assisted corneal biopsy can be used as an accurate diagnostic method in uncertain cases of corneal ulcers.
Adult ; Biopsy ; Humans ; Keratitis ; Keratoplasty, Penetrating

A new technique was proposed for the optical treatment of advanced cases of bullous keratopathy. Electrodiathermy (coagulation current of standard unit, 0.5-1 sec. small ball tip) on peripheral bullous area of recipient cornea, and then a partial penetrating keratoplasty(usually 6.0 ~ 7.0mm in diameter) on central bullous area of recipient corneas are main procedures. Young-donor corneas are used always, in fresh state. not exceeding 24 hours. Author performed this new technique on 8 eyes (6 patients; 2 patients on both eyes) of advanced bullous keratopathy. And among them 7 eyes (87.5%)showed successful crystal clear with improving useful vision, and only one eye(12.5%) showed opaque graft due to complicated glaucoma. Observation periodis, at least, from 12 months to 21 months.
Cornea ; Glaucoma ; Humans ; Keratoplasty, Penetrating* ; Transplants

Combined penetrating keratoplasty, cataract extraction, and lens implantation is the currently accepted treatment of choice for patients with combined corneal and cataract diseases. However, surgeons have met some difficulties and disadvantages of "Open sky" extracapsular cataract extraction during the triple procedure because of open-system approach. Thus, author contrive "Quadri" procedure ; Combined Phototherapeutic Keratectomy, Penetrating Keratoplasty, Phacoemulsification and Posterior Chamber Lens Implantation, for closed-system approach, and performed successfully.
Cataract ; Cataract Extraction ; Humans ; Keratoplasty, Penetrating* ; Phacoemulsification*

PURPOSE: To compare the accuracy and reproducibility of central corneal thickness measured by non-contact specular microscopy, ultrasound pachymetry, and Orbscan in the post-penetrating keratoplasty eyes. METHODS: Central corneal thickness was prospectively measured in eyes that had recieved penetrating keratoplasty at least 1 month before. One experienced technician measured all eyes using three methods; non-contact specular microscopy (Topcon SP-2000P; Topcon Corporation, Tokyo, Japan), Orbscan IIz (Orbtek; Bausch & Lomb, Rochester, USA), and ultrasound pachymetry (AL-2000; Tomey, Erlangen, Germany). Three consecutive measurements were performed using each method and the mean values and coefficient of variation were compared. RESULTS: The mean values of central corneal thickness were 550.7+/-63.3 micrometer with specular microscopy, 548.2+/-72.5 micrometer with ultrasound pachymetry, and 472.5+/-151.7 micrometer with Orbscan. There was no significant difference between the measurements obtained by specular microscopy and ultrasound pachymetry (p=0.53), and both methods showed high reproducibility. The corneal thickness measured by Orbscan was remarkably variable and in some patients, Orbscan was unable to measure corneal thickness. CONCLUSIONS: Non-contact specular microscopy appears to be an effective technique, potentially replacing ultrasound pachymetry for measuring central corneal thickness in the post-penetrating keratoplasty eyes.
Corneal Transplantation ; Humans ; Keratoplasty, Penetrating ; Microscopy ; Prospective Studies ; Ultrasonography

PURPOSE: To conform the effectiveness of Cyclosporin(CsA) in penetrating keratoplasty(PKP), we compared the survival rate of grafts between CsA-used group and CsA-unused group(control group) in high risk patients. MATERIAL AND METHOD: High risk cornea was defined as vascularization in 3 or 4 quadrants, recurrent graft or corneal surface disease. We reviewed the 74 eyes(74 patients) which received penetrating keratoplasty with high risk cornea, and compared the survival rate between CsA-used group and control group. RESULT: Twenty-nine of the 74 patients were treated with CsA(17 patients with topical CsA and 12 with oral CsA ). The survival rate of CsA-used group was not superior to that of control group. CONCLUSION: CsA seems not to be effective in graft survival of high risk PKP.
Cornea ; Cyclosporine* ; Graft Survival ; Humans ; Keratoplasty, Penetrating* ; Survival Rate ; Transplants

PURPOSE: Keratoconus is a bilateral noninflammatory ecstatic disease of cornea. Clinical manifestations and treatments are well-described , but the exact pathophysiology has many debates. There are many reports on pathologic abnormalities of keratoconus, but few reports on epithelial adhesion complex. The authors investigated the abnormalities in epithelial adhesion complex of keratoconus. METHODS: Using 4 corneas from 4 recipients of penetrating keratoplasty, examination was done with transmission electron microscope (Hitachi-600, Japan) after proper fixation and staining. Central and peripheral portion of each corneal tissues were examined. RESULTS: In two tissues, severe degeneration of basement membrane and Bowman's layer were found. Some degree of abnormalities was found in other tissues, which had minimal change. Some of hemidesmosomes, the most distinct part of adhesion complex, were found only in well-maintained tissue but the distribution was abnormal. CONCLUSIONS: The fact that basal plasma membrane had selectively more degenerations and changes than intercellular plasma membrane implies pathophysiology of keratoconus on adhesion complex, basal plasma membrane, basement membrane and Bowman's layer. Further study on this issue will reveal more information as to its pathophysiology.
Basement Membrane ; Cell Membrane ; Cornea ; Hemidesmosomes ; Keratoconus* ; Keratoplasty, Penetrating