Corneal topography-guided penetrating keratoplasty and suture adjustment: New approach for astigmatism control

Paolo Vinciguerra, Daniel Epstein, Elena Albè, Fernando Spada, Nadia Incarnato, Nicola Orzalesi, Pietro Rosetta

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

PURPOSE: To describe a new keratoplasty procedure using intraoperative topography to reduce postoperative astigmatism. METHODS: One hundred sixty-five eyes of 150 consecutive patients were enrolled in this prospective study. The most common diagnosis was keratoconus (78.8%). As many as 5.5% had post-laser in situ keratomileusis ectasia. Keratoplasty was performed with the Hanna Corneal Trephine System. A 24-bite running suture was placed, using a specially developed marker. Suture adjustment was performed with the aid of an intraoperative topographer (Keratron Scout; OPTIKON 2000, Rome, Italy). The aim of the adjustment was to obtain an astigmatism ≤2.0 D on the operating table. In case of >3.0 D of astigmatism at 1 month after surgery, suture adjustment was performed using the same intraoperative topographer. RESULTS: At 12 months postoperatevely (suture in), data from 108 (64%) eyes were available. The mean refractive astigmatism was 3.53 D, and the mean topographical astigmatism was 4.7 D. At 18 months (suture out), data from 32 eyes (19.4%) were available, and at 24 months, data from 29 eyes (13.3%) were available. The mean refractive astigmatism was 3.39 D at 18 months and 3.47 D at 24 months. The mean topographic astigmatism was 2.30 D at 18 months and 1.76 D at 24 months. Mean best spectacle-corrected visual acuity (BSCVA) was 0.51 at 3 months, 0.63 at 12 months (suture in), 0.67 at 18 months (suture out), and 0.78 at 24 months postoperatively. CONCLUSIONS: The combination of intraoperative topography and a 24-bite single running suture resulted in a stable astigmatism throughout the follow-up period, even after suture removal. BSCVA reached a 20/40 level as early as 3 months postoperatively and continued to rise after suture removal. The stability of astigmatism and BSCVA shortened the postoperative visual rehabilitation time and provided a high quality of vision early in the postoperative period.

Original languageEnglish
Pages (from-to)675-682
Number of pages8
JournalCornea
Volume26
Issue number6
DOIs
Publication statusPublished - Jul 2007

Fingerprint

Corneal Topography
Social Adjustment
Penetrating Keratoplasty
Astigmatism
Sutures
Visual Acuity
Corneal Transplantation
Bites and Stings
Operating Tables
Pathologic Dilatations
Keratoconus
Laser In Situ Keratomileusis
Postoperative Period
Italy
Rehabilitation
Prospective Studies

Keywords

  • Astigmatism
  • Intraoperative topography
  • Perforating keratoplasty

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Corneal topography-guided penetrating keratoplasty and suture adjustment : New approach for astigmatism control. / Vinciguerra, Paolo; Epstein, Daniel; Albè, Elena; Spada, Fernando; Incarnato, Nadia; Orzalesi, Nicola; Rosetta, Pietro.

In: Cornea, Vol. 26, No. 6, 07.2007, p. 675-682.

Research output: Contribution to journalArticle

Vinciguerra, Paolo ; Epstein, Daniel ; Albè, Elena ; Spada, Fernando ; Incarnato, Nadia ; Orzalesi, Nicola ; Rosetta, Pietro. / Corneal topography-guided penetrating keratoplasty and suture adjustment : New approach for astigmatism control. In: Cornea. 2007 ; Vol. 26, No. 6. pp. 675-682.
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abstract = "PURPOSE: To describe a new keratoplasty procedure using intraoperative topography to reduce postoperative astigmatism. METHODS: One hundred sixty-five eyes of 150 consecutive patients were enrolled in this prospective study. The most common diagnosis was keratoconus (78.8{\%}). As many as 5.5{\%} had post-laser in situ keratomileusis ectasia. Keratoplasty was performed with the Hanna Corneal Trephine System. A 24-bite running suture was placed, using a specially developed marker. Suture adjustment was performed with the aid of an intraoperative topographer (Keratron Scout; OPTIKON 2000, Rome, Italy). The aim of the adjustment was to obtain an astigmatism ≤2.0 D on the operating table. In case of >3.0 D of astigmatism at 1 month after surgery, suture adjustment was performed using the same intraoperative topographer. RESULTS: At 12 months postoperatevely (suture in), data from 108 (64{\%}) eyes were available. The mean refractive astigmatism was 3.53 D, and the mean topographical astigmatism was 4.7 D. At 18 months (suture out), data from 32 eyes (19.4{\%}) were available, and at 24 months, data from 29 eyes (13.3{\%}) were available. The mean refractive astigmatism was 3.39 D at 18 months and 3.47 D at 24 months. The mean topographic astigmatism was 2.30 D at 18 months and 1.76 D at 24 months. Mean best spectacle-corrected visual acuity (BSCVA) was 0.51 at 3 months, 0.63 at 12 months (suture in), 0.67 at 18 months (suture out), and 0.78 at 24 months postoperatively. CONCLUSIONS: The combination of intraoperative topography and a 24-bite single running suture resulted in a stable astigmatism throughout the follow-up period, even after suture removal. BSCVA reached a 20/40 level as early as 3 months postoperatively and continued to rise after suture removal. The stability of astigmatism and BSCVA shortened the postoperative visual rehabilitation time and provided a high quality of vision early in the postoperative period.",
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AU - Vinciguerra, Paolo

AU - Epstein, Daniel

AU - Albè, Elena

AU - Spada, Fernando

AU - Incarnato, Nadia

AU - Orzalesi, Nicola

AU - Rosetta, Pietro

PY - 2007/7

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N2 - PURPOSE: To describe a new keratoplasty procedure using intraoperative topography to reduce postoperative astigmatism. METHODS: One hundred sixty-five eyes of 150 consecutive patients were enrolled in this prospective study. The most common diagnosis was keratoconus (78.8%). As many as 5.5% had post-laser in situ keratomileusis ectasia. Keratoplasty was performed with the Hanna Corneal Trephine System. A 24-bite running suture was placed, using a specially developed marker. Suture adjustment was performed with the aid of an intraoperative topographer (Keratron Scout; OPTIKON 2000, Rome, Italy). The aim of the adjustment was to obtain an astigmatism ≤2.0 D on the operating table. In case of >3.0 D of astigmatism at 1 month after surgery, suture adjustment was performed using the same intraoperative topographer. RESULTS: At 12 months postoperatevely (suture in), data from 108 (64%) eyes were available. The mean refractive astigmatism was 3.53 D, and the mean topographical astigmatism was 4.7 D. At 18 months (suture out), data from 32 eyes (19.4%) were available, and at 24 months, data from 29 eyes (13.3%) were available. The mean refractive astigmatism was 3.39 D at 18 months and 3.47 D at 24 months. The mean topographic astigmatism was 2.30 D at 18 months and 1.76 D at 24 months. Mean best spectacle-corrected visual acuity (BSCVA) was 0.51 at 3 months, 0.63 at 12 months (suture in), 0.67 at 18 months (suture out), and 0.78 at 24 months postoperatively. CONCLUSIONS: The combination of intraoperative topography and a 24-bite single running suture resulted in a stable astigmatism throughout the follow-up period, even after suture removal. BSCVA reached a 20/40 level as early as 3 months postoperatively and continued to rise after suture removal. The stability of astigmatism and BSCVA shortened the postoperative visual rehabilitation time and provided a high quality of vision early in the postoperative period.

AB - PURPOSE: To describe a new keratoplasty procedure using intraoperative topography to reduce postoperative astigmatism. METHODS: One hundred sixty-five eyes of 150 consecutive patients were enrolled in this prospective study. The most common diagnosis was keratoconus (78.8%). As many as 5.5% had post-laser in situ keratomileusis ectasia. Keratoplasty was performed with the Hanna Corneal Trephine System. A 24-bite running suture was placed, using a specially developed marker. Suture adjustment was performed with the aid of an intraoperative topographer (Keratron Scout; OPTIKON 2000, Rome, Italy). The aim of the adjustment was to obtain an astigmatism ≤2.0 D on the operating table. In case of >3.0 D of astigmatism at 1 month after surgery, suture adjustment was performed using the same intraoperative topographer. RESULTS: At 12 months postoperatevely (suture in), data from 108 (64%) eyes were available. The mean refractive astigmatism was 3.53 D, and the mean topographical astigmatism was 4.7 D. At 18 months (suture out), data from 32 eyes (19.4%) were available, and at 24 months, data from 29 eyes (13.3%) were available. The mean refractive astigmatism was 3.39 D at 18 months and 3.47 D at 24 months. The mean topographic astigmatism was 2.30 D at 18 months and 1.76 D at 24 months. Mean best spectacle-corrected visual acuity (BSCVA) was 0.51 at 3 months, 0.63 at 12 months (suture in), 0.67 at 18 months (suture out), and 0.78 at 24 months postoperatively. CONCLUSIONS: The combination of intraoperative topography and a 24-bite single running suture resulted in a stable astigmatism throughout the follow-up period, even after suture removal. BSCVA reached a 20/40 level as early as 3 months postoperatively and continued to rise after suture removal. The stability of astigmatism and BSCVA shortened the postoperative visual rehabilitation time and provided a high quality of vision early in the postoperative period.

KW - Astigmatism

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KW - Perforating keratoplasty

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