After the first description of epikeratoplasty for the correction of aphakia by Kaufman in 1980, the application of epikeratoplasty has been extended further to the treatment of keratoconus and high myopia. Six epikeratoplasty for five eyes of high myopia and one eye of keratoconus were performed and followed up for an average of 4.9 months. All cases improved their uncorrected visual acuity, and the preoperative best corrected visual acuity improved or had no change postoperatively except for one case. In the cases of high myopia, the mean preoperative spherical equivalent of -19.4 D was corrected to an average -0.23 D with a range of -1.0 D to +2.5 D postoperatively. In the case of keratoconus, there was a mean decrease in 12.0 D of myopia in terms of the spherical equivalent, and the cornea was flattened by over 8 D in keratometry readings.
Adolescent ; Adult ; *Corneal Transplantation ; Female ; Follow-Up Studies ; Humans ; Keratoconus/*surgery ; Male ; Myopia/*surgery ; Postoperative Care ; Visual Acuity

The 6 eyes of 6 patients operated on using keratoconic epikeratoplasty are evaluated, and the mean 11-month postoperative results are reported. Uncorrected visual acuities improved in 4 patients and were maintained in 1 patient. One patient revealed a decrease of uncorrected visual acuity in the postoperative 6th month. Two patients showed an improvement of over 2 Snellen lines. Two patients showed the same corrected visual acuity, and that of 2 patients decreased within the postoperative 6-months follow-up. There was a significant decrease of myopia in terms of spherical equivalent. As a result, 4 cases showed a postoperative refractive error from +1.0 to -2.5D. Two cases were myopic deviated, -4.0 and -5.0D, and need further observation. In all cases, there was an effective flattening of the protruding cone with a mean decrease of over 11D of keratometry readings. Complete reepithelization occurred within 12 days, (average 7.5 days) and a moderate pressure patch was used as a routine procedure to promote the reepithelization.
Adolescent ; Adult ; *Corneal Transplantation ; Female ; Follow-Up Studies ; Humans ; Keratoconus/*surgery ; Male ; Retrospective Studies ; Treatment Outcome ; Visual Acuity ; Wound Healing

We report the case of a 37-year-old man with a high myopic keratoconus eye that was treated with a posterior chamber toric implantable collamer lens (ICL) in Korea. The patient had a history of contact lens intolerance and did not want to have a corneal transplantation. His uncorrected visual acuity (UCVA) and best spectacle corrected visual acuity were 0.02 and 0.4 in the left eye, respectively. Preoperatively, the manifest refraction was -12.0 -3.5 x 30A. Postoperatively, the manifest refraction was -1.75 x 180A. UCVA improved markedly after implantation. No intraoperative or postoperative complications were observed during 20 months of follow-up. Toric ICL implantation may be a possible alternative surgical option for the visual rehabilitation of high myopic astigmatism in keratoconus patients with rigid gas permeable contact lens intolerance and in patients who do not want to get a corneal transplant.
Adult ; Follow-Up Studies ; Humans ; Keratoconus/*rehabilitation/*surgery ; *Lens Implantation, Intraocular ; Male ; *Phakic Intraocular Lenses ; *Visual Acuity

OBJECTIVE: To investigate the effects of corneal thickness distribution and apex position on postoperative refractive status after full-bed deep anterior lamellar keratoplasty (FBDALK). METHODS: This is a retrospective analysis of patients who were diagnosed with advanced keratoconus between 2011 and 2014 in our hospital. The base of the cone in all patients did not exceed the central cornea at a 6-mm range. The FBDALK was performed by a same surgeon. All patients had a complete corneal suture removal and the follow-up records were intact. Patients who had graft-bed misalignment or who were complicated with a cataract or glaucoma were excluded. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), and Pentacam examination data were recorded at two years postoperatively. The recorded data included the superior-inferior (S-I) and nasal-temporal (N-T) corneal thickness differences in 2, 4, 6, and 8 mm diameter concentric circles with the corneal apex as the center (S-I_{2 mm}, S-I_{4 mm}, S-I_{6 mm}, S-I_{8 mm}, N-T_{2 mm}, N-T_{4 mm}, N-T_{6 mm}, and N-T_{8 mm}), the linear, X-axis, and Y-axis distance between the corneal pupillary center and the cornea apex, total corneal astigmatism at a zone of 3 mm diameter from the corneal apex (TA_{3 mm}), the astigmatic vector values J₀ and J₄₅, and the corneal total higher-order aberration for 3 and 6 mm pupil diameters (HOA_{3 mm} and HOA_{6 mm}). Statistical analysis was performed by SPSS 15.0. RESULTS: A total of 47 eyes of 46 patients met the criteria and were included in this study. The mean follow-up time was (28±7) months. The mean UCVA was 0.45±0.23 (logMAR) (MAR: minimum angle of resolution) and the mean BSCVA was 0.19±0.15 (logMAR), which were all significantly positively correlated with postoperative TA_{3 mm} and HOA_{3 mm}. The mean S-I corneal thickness differences were (44.62±37.74) μm, and the mean N-T was (38.57±32.29) μm. S-I_{2 mm} was significantly positively correlated with J₀ (r=0.31), J₄₅ (r=0.42), HOA_{3 mm} (r=0.37), and HOA_{6 mm} (r=0.48). S-I_{4 mm} and S-I_{8 mm} were significantly positively correlated with HOA_{3 mm} (r=0.30, r=0.40) and HOA_{6 mm} (r=0.46, r=0.35). The X-axis distance between corneal pupillary center and corneal apex was significantly positively correlated with J₄₅ (r=0.29). CONCLUSIONS In patients with advanced keratoconus after FBDALK, the unevenly distributed thickness at corneal pupillary area and the misalignment of corneal apex and pupillary center might cause significant regular and irregular astigmatism, which affected the postoperative visual quality.
Adolescent ; Adult ; Cornea/surgery* ; Corneal Transplantation/methods* ; Cryopreservation ; Female ; Follow-Up Studies ; Humans ; Keratoconus/diagnosis* ; Keratoplasty, Penetrating/methods* ; Male ; Retrospective Studies ; Visual Acuity ; Young Adult

A 49-year-old man with an uncorrected visual acuity (UCVA) of 20 / 1000, a best spectacle-corrected visual acuity (BSCVA) of 20 / 400, keratometric readings of K1 = 59.88 x 82degrees / K2 = 45.88 x 172degrees, and an inferior steepening that was consistent with keratoconus in his left eye was treated with clear-cornea phacoemulsification and an intraocular lens (IOL) implantation after insertion of keraring intrastromal corneal ring segments for severe keratoconus and cataract. An asymmetrical pair of kerarings was implanted with the assistance of a femtosecond laser in September 2008; the one segment was 250 microm and the other was 150 microm and both were placed at 70degrees. Three months after the kerarings were implanted, clear-cornea phacoemulsification and IOL implantation were performed on the left eye. After surgery, both the UCVA and the BSCVA of the left eye improved by eight lines. Postoperative central keratometry showed a decrease of 7.35 diopters in the left eye. Both the postoperative refraction (-0.75 -0.75 x 60degrees) and the keratometric reading (K1 = 50.05 x 93degrees / K2 = 48.83 x 3degrees) remained stable one month following the procedures. Thus, the sequential order of intrastromal corneal rings implantation and cataract surgery can be considered as a treatment option in patients with severe keratoconus and cataract.
Cataract/*complications/diagnosis ; Corneal Stroma/pathology/*surgery ; Corneal Topography ; Follow-Up Studies ; Humans ; Keratoconus/complications/diagnosis/*surgery ; Lens Implantation, Intraocular/*methods ; Male ; Middle Aged ; Phacoemulsification/*methods ; Severity of Illness Index

PURPOSE: To compare the clinical outcomes between deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) with same-size grafts in patients with keratoconus. METHODS: Medical records of 16 eyes from 15 patients treated from June 2005 through April 2011 were retrospectively reviewed. Patients with contact lens intolerance or who were poor candidates for contact lens fitting due to advanced cone underwent keratoplasty. The transplantations consisted of 11 DALK and 5 PKP with same-size grafting for keratoconus. Best-corrected visual acuity (BCVA), refractive error, corneal topographic profiling, and clinical course were compared between DALK and PKP groups. RESULTS: The follow-up period was 30 +/- 17 months in the DALK group and 45 +/- 20 months in the PKP group (p = 0.145). At final follow-up, the DALK and PKP groups achieved a BCVA (logarithm of the minimum angle of resolution) of 0.34 and 0.52, respectively (p = 0.980). Postoperative refractive error and mean simulated keratometric index showed myopic astigmatism in both groups without any statistical difference. Corneal irregularity index measured at 5 mm in the DALK group was less than that of the PKP group at 1-year follow-up (p = 0.021); however, at final follow-up, there was no longer a statistically significant difference. Endothelial cell counts were lower in the PKP group than in the DALK group at final follow-up (p = 0.021). CONCLUSIONS: The optical outcomes of DALK with same-size grafts for keratoconus are comparable to those of PKP. Endothelial cell counts are more stable in DALK compared to PKP.
Adult ; Cornea/pathology/surgery ; Corneal Topography ; Female ; Follow-Up Studies ; Humans ; Keratoconus/pathology/physiopathology/*surgery ; Keratoplasty, Penetrating/*methods ; Male ; *Refraction, Ocular ; Retrospective Studies ; Time Factors ; Tissue and Organ Harvesting/*methods ; Treatment Outcome