Chirurgische Astigmatismuskorrektur nach perforierender Keratoplastik

  • P. C. Jacobi
  • C. Hartmann
  • M. Severin
  • K.-U. Bartz-Schmidt
Conference paper

Zusammenfassung

Die vorliegende Studie umfaßt 25 Patienten nach perforierender Keratoplastik, die in Folge eines hohen, konservativ nicht korrigierbaren Astigmatismus einer refraktiven Hornhautchirurgie unterzogen wurden. Als refraktives Verfahren wurden relaxierende Inzisionen im Bereich des Narbenringes kombiniert mit Kompressionsnähten in senkrechter Achse hierzu angewendet. Der absolute präoperative Astigmatismus reichte von 4,0 bis 25,0 dpt und lag im Mittel bei 11,7 ±4,9 dpt. Postoperativ schwankte er zwischen 2,0 und 15,0 dpt (im Mittel±SD: 6,2±2,7). Der Netto-Effekt lag bei 6,1 ±4,3 dpt. Der vektorkorrigierte Astigmatismus lag zwischen 4,2 und 21,7 dpt (im Mittel: 13,1 ±5,7 dpt).

Als unvermeidbare Nebenwirkung erwies sich eine Myopisierung von im Mittel 4,7 ± 6,9 dpt sphärisches Äquivalent. Das beschriebene Verfahren erweist sich als geeignet, einen störenden Astigmatismus nach perforierender Keratoplastik zu reduzieren; auch wenn die Vorhersagbarkeit des gewünschten Effektes noch immer nicht zufriedenstellend ist.

Summary

We report 25 cases of postkeratoplasty astigmatism, ranging from 4.5 to 25.0 diopters treated with relaxing incisions and compression sutures. Nineteen eyes regained a functional vision of 0.4 or better. Commonly, relaxing incisions were placed in the graft-host interface. 10–0 nylon compression sutures were placed perpendicular to the incisions. After first keratotomy the average time of follow-up was 23 months (range, 3 months to 5 years). The mean preoperative astigmatism was 11.7 ±4.9 diopters, and the mean postoperative astigmatism was 6.2±2.7 (range, 2.0 to 15.0 dpt). The net decrease in astigmatism was 6.1 ±4.3 dpt (range, 0.5 to 19.0 dpt), which represents a 47±21% decrease in astigmatism. The mean vector-corrected change in astigmatism was 13.1 ±5.7 (range, 4.2–21.7 dpt), resembling a percentage of effect of 102±49.4% (range, 32 to 238%). As an inevitable side-effect refractive procedures resulted in a myopic shift (4.7 ± 6.9 dpt) in spherical equivalence. Relaxing incisions and compression sutures are most useful procedures reducing disturbing postkeratoplasty astigmatism. However, predictability still remains unsatisfactory and more than one operation may be required.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. 1.
    Binder PS (1986) Controlled reduction of postkeratoplasty astigmatism. In: Brightbill FS (ed) Corneal surgery — theory, technique, and tissue. Mosby, St. Louis Washington DC Toronto, pp 326–332Google Scholar
  2. 2.
    Lindström RL, Lavery GW (1986) Correction of postkeratoplasty astigmatism. In: Brightbill FS (ed) Corneal surgery — theory, technique, and tissue. Mosby, St. Louis Washington DC Toronto, pp 333–343Google Scholar
  3. 3.
    Mandel Mr, Shapiro MB, Krachmer JH (1987) Relaxing incisions with argumentation sutures for the correction of postkeratoplasty astigmatism. Am J Ophthalmol 103: 441–447Google Scholar
  4. 4.
    Swinger CA (1987) Postoperative astigmatism. Surv Ophthalmol 31:219–248PubMedCrossRefGoogle Scholar
  5. 5.
    Limberg MB, Dingeldein SA, Green MT, Klyce SD, Insler MS, Kaufman HE (1989) Corneal compression sutures for the reduction of astigmatism after penetrating keratoplasty. Am J Ophthalmol 108:36–42PubMedGoogle Scholar
  6. 6.
    Jensen AD, Maumenee AE (1974) Refractive errors following keratoplasty. Trans Am Ophthalmol Soc 72:123–131PubMedGoogle Scholar
  7. 7.
    Lindström RL, Lindquist TD (1988) Surgical correction of postoperative astigmatism. Cornea 7:138–148PubMedCrossRefGoogle Scholar
  8. 8.
    Troutman RC, Swinger CA (1980) Relaxing incisions for control of postoperative astigmatism following keratoplasty. Ophthalmic Surg 11:117–120PubMedGoogle Scholar
  9. 9.
    Troutman RC (1983) Corneal wedge resection and relaxing incisions for postkeratoplasty astigmatism. Int Ophthalmol Clin 23:161–168PubMedCrossRefGoogle Scholar
  10. 10.
    Hartmann C (1990) Zur chirurgischen Astigmatismuskorrektur nach Keratoplastik. Jahrestagung Bayr Augenärzte, München 18./19.5.Google Scholar
  11. 11.
    Jaffe NS, Clayman HN (1975) The pathophysiology of corneal astigmatism after cata-ractextraction. Trans Am Acad Ophthalmol Otol 97:615–630Google Scholar
  12. 12.
    Fronterre A, Portesani GP (1991) Relaxing incisions for postkeratoplasty astigmatism. Cornea 10:305–311PubMedCrossRefGoogle Scholar
  13. 13.
    Krachmer Jh, Fenzel RE (1980) Surgical correction of high postkeratoplasty astigmatism. Arch Ophthalmol 948:1400–1402CrossRefGoogle Scholar
  14. 14.
    Sugar J, Kirk AK (1983) Relaxing keratotomy for postkeratoplasty high astigmatism. Ophthalmic Surg 16:165–169Google Scholar
  15. 15.
    Lundergan MK, Rowsey JJ (1985) Relaxing incisions. Ophthalmology 92:1226–1236PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • P. C. Jacobi
  • C. Hartmann
  • M. Severin
  • K.-U. Bartz-Schmidt

There are no affiliations available

Personalised recommendations