Szczotka-Flynn Loretta, McMahon Timothy T, Lass Jonathan H, Sugar Joel, Weissman Barry A, Stiegemeier Mary Joe, Reinhart William J
Department of Ophthalmology, Case Western Reserve University, Cleveland, OH, USA.
Eye Contact Lens. 2004 Apr;30(2):105-10. doi: 10.1097/01.icl.00000118526.35929.0f.
Progressive corneal astigmatism occurring at least 10 years after penetrating keratoplasty for keratoconus is a late-phase complication of surgery. This report characterizes this condition in a series of patients from three corneal referral centers in the United States.
Charts were retrospectively reviewed which met the following criteria: penetrating keratoplasty performed for keratoconus at least 10 years ago, keratometry or simulated keratometry from topography as well as manifest refraction recorded at least 6 months after the last suture removal ("baseline"), and an increase in corneal astigmatism of at least three D over baseline recorded at least 5 years later. Patients who had any other corneal or intraocular surgery performed were excluded.
Data from 15 patients (11 males and 4 females) who had penetrating keratoplasties performed by 8 different surgeons are included in this descriptive series. Postoperative follow-up averaged 17.27 years (range 11-24 years). The average donor button size was 7.83 mm (range 7.25-8.5 mm). Baseline corneal astigmatism was obtained an average of 5.2 years after penetrating keratoplasty (range 1.5-16 years) and was on average 3.57 +/- 1.8 D (10 with-the-rule [WTR], 3 against-the-rule [ATR], 2 oblique). Corneal astigmatism significantly increased to an average of 11.23 +/- 3.56 D (range 8.00-19.37 D, P < 0.0001) and most astigmatism was regular and WTR (9 WTR, 3 ATR, 3 oblique) 15.3 years (range 10-22 years) after surgery. Inferior steepening on topography was often noted, even those with oblique and ATR axes.
High, late-stage, regular astigmatism after penetrating keratoplasty for keratoconus is described in a series of patients occurring at least 10 years after surgery. Possible mechanisms of this progressive astigmatism are recurrence of keratoconus in the graft, progressive corneal thinning of the host cornea, or progressive misalignment of the graft-host interface over time.
圆锥角膜穿透性角膜移植术后至少10年出现的进行性角膜散光，是手术的晚期并发症。本报告描述了来自美国三个角膜转诊中心的一系列患者的这种情况。
回顾性查阅符合以下标准的病历：至少在10年前因圆锥角膜进行穿透性角膜移植术，在最后一次缝线拆除后至少6个月记录角膜曲率测量或地形图模拟角膜曲率测量以及明显验光（“基线”），并且至少在5年后记录角膜散光比基线增加至少3D。排除曾进行过任何其他角膜或眼内手术的患者。
本描述性系列纳入了15例患者（11例男性和4例女性）的数据，这些患者接受了8位不同外科医生进行的穿透性角膜移植术。术后平均随访17.27年（范围11 - 24年）。平均供体植片大小为7.83mm（范围7.25 - 8.5mm）。穿透性角膜移植术后平均5.2年（范围1.5 - 16年）获得基线角膜散光，平均为3.57±1.8D（10例顺规[WTR]，3例逆规[ATR]，2例斜轴）。角膜散光显著增加至平均11.23±3.56D（范围8.00 - 19.37D，P < 0.0001），并且大多数散光在术后15.3年（范围10 - 22年）时是规则的且为顺规（9例顺规，3例逆规，3例斜轴）。地形图上常可见下方陡峭，即使是斜轴和逆规轴的患者。
本系列描述了圆锥角膜穿透性角膜移植术后至少10年出现的高度、晚期、规则散光。这种进行性散光的可能机制是移植片中圆锥角膜复发、宿主角膜进行性变薄或随着时间推移移植片 - 宿主界面逐渐错位。
