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Chapter-14 Refractive Surgery after Penetrating Keratoplasty

BOOK TITLE: Keratoconus Surgery and Cross-linking

Author
1. Guell José L
2. Morral Merce
3. Manero Felicidad
ISBN
9788184486506
DOI
10.5005/jp/books/10434_14
Edition
1/e
Publishing Year
2009
Pages
18
Author Affiliations
1. Instituto De Micero Cirugia Ocular (IMO), Universitat Autonoma De Barcelona, Barcelona, Spain, Instituto De Microcirugia Ocular, De Barcelona, Barcelona, Spain, Instituto De Microcirugia Ocular (IMO), Universitat Autonoma De Barcelona, Barcelona, Spain, Instituto de Microcirugia Ocular, Barcelona, Spain, Autonoma University of Barcelona; Instituto Microcirugia Ocular de Barcelona, Munner 10, Barcelona 08022, Spain
2. Instituto de Microcirugia Ocular, Barcelona, Spain, Instituto Microcirugia Ocular (IMO); Barcelona, Spain, Institut Clinic d’Oftalmologia (ICOF), Hospital, Clinic Provincial, Barcelona, Spain, Plaza Bonanova 11, 2-2, 08022 Barcelona, Spain
3. Instituto de Microcirugia Ocular, Barcelona, Spain, Instituto Microcirugia Ocular of Barcelona, Munner, Barcelona 10 08022, Spain
Chapter keywords

Abstract

Refractive anisometropia and high postoperative astigmatism are common problems after penetrating keratoplasty (PKP) and can jeopardize patient’s visual rehabilitation and return to binocular function. Several factors determining residual astigmatism after PKP. Some may be controlled by the surgeon and others not, and include: Corneal hydration, Epitelial/stromal wound healing, Remodeling, May be controlled by surgeon: Donor’s refractive characteristics, Graft-host interactions. Sutures Both Lasik and PRK have been used to correct refractive errors after PKP. Indications and contraindication for Lasik for residual ametropia after penetrating keratoplasty indications: Refractive stability at least 6 month after extraction of sutures. Minimal maintenance or no topical corticosteroids. CCT > 500 µm. Residual stromal bed > 250 µm. Sim K 38–55 D. Contraindications: Graft rejection, recurrence of herpetic ocular disease, or inflammatory condition. “Marked peripheral corneal vascularization. Significant corneal anesthesia. Thin host tissue. Wound ectasia. Significant graft override/wound malapposition. Inclusion and exclusion criteria for implantation of phakic IOL are summarized. “Inclusion criteria: Age > 21 years. Stability of refraction at least 1 year. Ametropia not correctable with excimer laser surgery. Unsatisfactory vision with/intolerance of contact lenses or spectacles.“ Irido-corneal angle ³ 30° cECC >2300 cell/mm. No anomaly of the iris or pupil function scotopic pupil size < 5-6 mm Toric PIOL if astigmatism > 2D Exclusion criteria: Background of active disease in the anterior segment, Recurrent or chronic uveitis, Any form of clinically significant cataract, Previous corneal or intraocular surgery, IOP > 21 mmHg or glaucoma, Abnormal retinal condition, Systemic diseases (e.g. autoimmune disorder, atopia, diabetes mellitus).

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