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Corneal biomechanical properties in eyes with no previous surgery, with previous penetrating keratoplasty and with deep anterior lamellar keratoplasty

Abstract

Purpose

To compare the biomechanical properties of the cornea in eyes with no previous surgery, with keratoconus with previous penetrating keratoplasty (PK) and with keratoconus with previous deep anterior lamellar keratoplasty (DALK) using the Reichert Ocular Response Analyzer (ORA).

Methods

One hundred twenty eyes of 120 patients were included in this prospective comparative study. Forty eyes were with no previous ocular surgery (group 1), 40 eyes were with previous PK for keratoconus (group 2), and 40 eyes were with previous DALK for keratoconus (group 3). Corneal hysteresis (CH) and the corneal resistance factor (CRF) were measured with ORA.

Results

The CH and CRF values in group 2 were significantly lower than in group 1 and group 3 (p = 0.001). The CH and CRF values were similar in group 1 and group 3. There was no statistically significant difference between group 1 and 3.

Conclusion

Although the post-PK keratoconus cornea has weaker biomechanical properties, post-DALK keratoconus cornea is similar to normal cornea. A cornea weakened by keratoconus can be strengthened with lamellar keratoplasty.

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References

  1. Rabinowitz YS. Keratoconus (Review). Surv Ophthalmol. 1998;42:297–319.

    PubMed  Article  CAS  Google Scholar 

  2. Kim KH, Choi SH, Ahn K, Chung ES, Chung TY. Comparison of refractive changes after deep anterior lamellar keratoplasty and penetrating keratoplasty for keratoconus. Jpn J Ophthalmol. 2011;55:93–7.

    PubMed  Article  Google Scholar 

  3. Li X, Rabinowitz YS, Rasheed K, Yang H. Longitudinal study of the normal eyes in unilateral keratoconus patients. Ophthalmology. 2004;111:440–6.

    PubMed  Article  Google Scholar 

  4. Yenerel NM, Kucumen RB, Gorgun E. Changes in corneal biomechanics in patients with keratoconus after penetrating keratoplasty. Cornea. 2010;29:1247–51.

    PubMed  Article  Google Scholar 

  5. Fontes BM, Ambrósio R Jr, Jardim D, Velarde GC, Nosé W. Corneal biomechanical metrics and anterior segment parameters in mild keratoconus. Ophthalmology. 2010;117:673–9.

    PubMed  Article  Google Scholar 

  6. Reinhart WJ, Musch DC, Jacobs DS, Lee WB, Kaufman SC, Schtein RM. Deep anterior lamellar keratoplasty as an alternative to penetrating keratoplasty a report by American Academy of Ophthalmology. Ophthalmology. 2011;118:209–18.

    PubMed  Article  Google Scholar 

  7. Javadi MA, Feizi S, Yazdani S, Mirbabaee F. Deep anterior lamellar keratoplasty versus penetrating keratoplasty for keratoconus. A clinical trial. Cornea. 2010;29:365–71.

    PubMed  Google Scholar 

  8. Luce DA. Determining in vivo biomechanical properties of the cornea with an ocular response analyzer. J Cataract Refract Surg. 2005;31:156–62.

    PubMed  Article  Google Scholar 

  9. Feizi S, Einollahi B, Yazdani S, Hashemloo A. Graft biomechanical properties after penetrating keratoplasty in keratoconus. Cornea. 2012;31:855–8

    Google Scholar 

  10. Shah S, Laiquzzaman M, Bhojwani R, Mantry S, Cunliffe I. Assessment of the biomechanical properties of the cornea with the ocular response analyzer in normal and keratoconic eyes. Invest Ophthalmol Vis Sci. 2007;48:3026–31.

    PubMed  Article  Google Scholar 

  11. Anwar M, Teichmann KD. Big-bubble technique to bare Descemet’s membrane in anterior lamellar keratoplasty. J Cataract Refract Surg. 2002;28:398–403.

    PubMed  Article  Google Scholar 

  12. Troutman RC, Lawless MA. Penetrating keratoplasty for keratoconus. Cornea. 1987;6:298–305.

    PubMed  Article  CAS  Google Scholar 

  13. Lim L, Pseudovs K, Coster DJ. Penetrating keratoplasty for keratoconus: visual outcome and success. Ophthalmology. 2000;107:1125–31.

    PubMed  Article  CAS  Google Scholar 

  14. Melles GR, Lander F, Rietvelt FJ, Remeijer L, Beekhuis WH, Binder PS. A new surgical technique for deep stromal, anterior lamellar keratoplasty. Br J Ophthalmol. 1999;83:327–33.

    PubMed  Article  CAS  Google Scholar 

  15. Al-Torbak AA, Al-Motowa S, Al-Assiri A, Al-Kharashi S, Al-Shahwan S, Al-Mezaine H, et al. Deep anterior lamellar keratoplasty for keratoconus. Cornea. 2006;25:408–12.

    PubMed  Google Scholar 

  16. Shin JY, Choi SJ, Oh JY, Kim MK, Lee JH, Wee WR. Evaluation of corneal biomechanical properties following penetrating keratoplasty using the ocular response analyzer. Korean J Ophthalmol. 2010;24:139–42.

    PubMed  Article  Google Scholar 

  17. Edmund C. Assessment of an elastic model in the pathogenesis of keratoconus. Acta Ophthalmol. 1987;65:545–50.

    CAS  Google Scholar 

  18. Foster CS, Yamamato GK. Ocular rigidity in keratoconus. Am J Ophthalmol. 1978;86:802–6.

    PubMed  CAS  Google Scholar 

  19. Edmund C. Corneal rigidity and ocular rigidity in normal and keratoconic eyes. Acta Ophthalmol. 1988;66:134–40.

    CAS  Google Scholar 

  20. Hartstein J, Becker B. Research into the pathogenesis of keratoconus: a new syndrome low ocular rigidity, contact lenses and keratoconus. Arch Ophthalmol. 1970;84:728–9.

    PubMed  Article  CAS  Google Scholar 

  21. Ortiz D, Pinero D, Shabayek MH, Arnalich-Montiel F, Alió JL. Corneal biomechanical properties in normal, post laser in situ keratomileusis, and keratoconic eyes. J Cataract Refract Surg. 2007;33:1371–5.

    PubMed  Article  Google Scholar 

  22. Qazi MA, Sanderson JP, Mahmoud AM, Yoon EY, Robetrs CJ, Pepose JS. Postoperative changes in intraocular pressure and corneal biomechanical metrics-Laser in situ keratomileusis versus laser assisted subepithelial keratectomy. J Cataract Refract Surg. 2009;35:1774–88.

    PubMed  Article  Google Scholar 

  23. Kamiya K, Shimizu K, Ohmoto F. The changes in corneal biomechanical parameters after phototherapeutic keratectomy in eyes with granular corneal dystrophy. Eye. 2009;23:1790–5.

    PubMed  Article  CAS  Google Scholar 

  24. Randleman JB, Russell B, Ward MA, Thompson KP, Stulting RD. Risk factors and prognosis for corneal ectasia after LASIK. Ophthalmology. 2003;110:267–75.

    PubMed  Article  Google Scholar 

  25. Wittig-Silva C, Whiting M, Lamoureux E, Lindsay RG, Sullivan LJ, Snibson GR. A randomized controlled trial of corneal collagen cross-linking in progressive keratoconus: preliminary results. J Refract Surg. 2008;24:720–5.

    Google Scholar 

  26. Raiskup-Wolf F, Hoyer A, Spoerl E, Pillunat LE. Collagen cross-linking with riboflavin and ultraviolet—a light in keratoconus: long-term results. J Cataract Refract Surg. 2008;34:796–801.

    PubMed  Article  Google Scholar 

  27. Vinciguerra P, Albe E, Mahmoud MM, Trazza S, Hafezi F, Roberts CJ. Intra- and postoperative variation in ocular response analyzer parameters in keratoconic eyes after corneal cross-linking. J Refract Surg. 2010;26:669–76.

    PubMed  Article  Google Scholar 

  28. Jafarinasab MR, Sepehr F, Javadi MA, Hashemloo A. Graft biomechanical properties after penetrating keratoplasty versus deep anterior lamellar keratoplasty. Curr Eye Res. 2011;36:417–21.

    PubMed  Article  Google Scholar 

  29. Hosny M, Hassaballa MAM, Shalaby A. Changes in corneal biomechanics following different keratoplasty techniques. Clin Ophthalmol. 2011;5:767–70.

    PubMed  Article  Google Scholar 

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Correspondence to Banu Torun Acar.

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Acar, B.T., Akdemir, M.O. & Acar, S. Corneal biomechanical properties in eyes with no previous surgery, with previous penetrating keratoplasty and with deep anterior lamellar keratoplasty. Jpn J Ophthalmol 57, 85–89 (2013). https://doi.org/10.1007/s10384-012-0197-5

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  • DOI: https://doi.org/10.1007/s10384-012-0197-5

Keywords

  • Corneal hysteresis
  • Corneal resistance factor
  • Deep anterior lamellar keratoplasty
  • Keratoconus
  • Penetrating keratoplasty