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*

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

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

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

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*

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*

We investigated mean keratometric vale(K) after penetrating keratoplasty(PKP) and analyzed the factors which affected the postoperative mean K. We obtained mean K at postoperative 3 months in the 65 eyes of 65 patients which PKP of PKP combined with intraocular lens(IOL) implantation was done, and analyzed those values according to sex, age, preoperative diagnosis, preoperative corneal neovascularization, methods of trephination, methods of suture and methods of operation. The postoperative mean K of all patients was 42.83 diopters(D) and 43.32D in the recipient cornea without neovascularizaion, 42.51D with neovascularization, 42.72D in the cases of hand-held trephination and 43.27D in Hessvurg-Varron trephination, which had no statistical significant difference between K and sex, age, preoperative diagnosis, methods of suture, and methods of operation. This results will be helpful to predict the change of K ofter PKP, and give a better refractive results to use the operator's own mean K for the IOL calculation in the case of PKP comvined with IOL implantation.
Cornea ; Corneal Neovascularization ; Diagnosis ; Humans ; Keratoplasty, Penetrating* ; Sutures ; Trephining

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 evaluate the parameters of tear function and ocular surface changes with time course after penetrating keratoplasty (PKP). METHODS: Corneal sensitivity test (CST), tear film break-up time (BUT), basal tear secretion test (BST), tear clearance test (Tcr), fluorescein staining and conjunctival impression cytology were evaluated in 21 eyes of 21 patients who underwent PKP at 1, 3 and 6 months postoperatively. RESULTS: CST (p=0.02), BST (p=0.04), fluorescein scoring (p=0.03), and goblet cell density (p=0.03) showed improving tendency during 6 month after surgery, but BUT (p=0.11), Tcr (p=0.65) and squamous metaplasia (p=0.20) did not change significantly. One month after surgery, CST (p<0.01), BUT (p=0.01), BST (p<0.01), and goblet cell density (p=0.01) were lower, while fluorescein staining score (p<0.01) and the grade of squamous metaplasia (p=0.03) were higher in PKP group. Six months after surgery, CST (p<0.01) and goblet cell density (p=0.04) were lower, and fluorescein staining score (p<0.01) was higher in PKP group. CONCLUSIONS: Tear film and ocular surface are compromised after PKP and improved gradually during postoperative 6 months. However, these parameters were not recovered completely to the normal level.
Fluorescein ; Goblet Cells ; Humans ; Keratoplasty, Penetrating* ; Metaplasia ; Tears*