Assiut university researches
Refractive surgery following corneal graft
Jorge L. Alio´a,b, Ahmed A. Abdoua,e, Ahmed A. Abdelghanya,c,
and Ghassam Zeind
Abstract:
Purpose of review To review the different surgical procedures
for management of postkeratoplasty refractive errors after
total suture removal. Recent findings There are different
surgical options to address residual refractive errors that
frequently occur after corneal transplantation. The correction
can be done on the corneal surface or intraocular with
intraocular lens (IOL) implantation which requires complete
tectonic and refractive stability after suture removal. The most
commonly used procedures are photorefractive keratectomy,
laser in-situ keratomileusis and Phakic IOLs. Keratoplasty
has been profited by recent advances in refractive surgery.
Custom excimer laser ablation is an alternative way to treat
irregular errors. New IOL modalities are good practical
options for a wide range of errors. Femtosecond laser, as a
new option in the toolbox, can modify corneal grafting
refractive results and assist corrective refractive procedures.
Summary Although being the most successful organ
transplantation, keratoplasty is usually followed by significant
ametropia. Different corrective modalities exist and the choice
should fit ocular conditions, patient requirements, surgeon
skills and the available technologies. Recent advances in
ophthalmic surgery have improved the outcomes.
Key words:
femtosecond laser, keratoplasty, laser in-situ keratomileusis,
phakic IOL, photorefractive keratectomy INTRODUCTION
Corneal graft surgeries, even the uncomplicated ones, are
prone to be followed by significant degrees of ametropia with
delayed visual rehabilitation, rendering the refractive outcome
unsatisfactory [1,2]. Although it is the most successful organ
transplantation, unfortunately the resultant refractive errors
for both penetrating and nonpenetrating keratoplasty usually
need correction [3,4,5&]. The most common refractive error
after penetrating and anterior lamellar keratoplasty is
astigmatism (regular and irregular), followed by myopia
[3,6,7]. Although refractive errors after endothelial
keratoplasty are minimal, hyperopic shift has been reported
[8,9]. In many cases, the induced anisometropia cannot be
fully corrected with glasses and contact lenses, entailing
surgical correction [6]. In this review, we will try to clarify the
management of residual postkeratoplasty refractive error and
evaluate the different corneal and lenticular surgical
procedures that can be used, after suture removal, for
uncomplicated corneal grafting. FACTORS AFFECTING
REFRACTIVE OUTCOME AFTER KERATOPLASTY Many
variables influence the refractive outcome in corneal
transplantation. The preoperative causes are related to the
host tissue (pathology, vascularization, IOP and scleral
rigidity) and the donor tissue (graft quality, peripheral
changes and refractive status) [7,10]. The variabilities in graft
size and shape, and suturing technique and suturematerials
are the intraoperative causes [7,11,12]. Unpredicted
postoperative wound healing is a major cause of variability
that can be attributed to the previous factors and to
postoperative tissue reactions and medications [7]. aVissum
Corporation, bDivision of Ophthalmology, Universidad Miguel
Herna´ ndez, cOphthalmology Department, Faculty of
Medicine, Minia University, Egypt, dOphthalmology
Department, Ahmadi Hospital, Kuwait and eOphthalmology
Department, AUH, Assiut University, Egypt Correspondence
to Jorge L. Alio´ , MD, PhD, Avda de Denia s/n,
EdificioVissum, 03016 Alicante, Spain. Tel: +34 902333444;
fax: +34 965160468; e-mail: jlalio@vissum.com Curr Opin
Ophthalmol 2015, 26:278–287
DOI:10.1097/ICU.0000000000000161 www.co-
Published in:
co-ophthalmology.,Vol. 26 - No. 4,pp. 278 -287