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Causes of high astigmatism after penetrating keratoplasty

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Abstract

We retrospectively evaluated the factors which might have caused excessive corneal astigmatism after penetrating keratoplasty (PKP) in 29 eyes, in which surgical correction of astigmatism was indicated. In 18 eyes high astigmatism (5 diopters or more) existed before suture removal probably due to graft elevation (3×), wound dehiscence (3×), wound configuration abnormalities such as ovality/overcut (8×), and a thin recipient cornea (2×). The cause was unknown in 2 eyes. In 19 eyes the astigmatism considerably increased after all sutures were removed; astigmatism increased an average of 8.8 diopters (range, 5 to 16.5 D). Ten of these 19 patients showed graft elevation, despite the fact that the sutures were only removed after an average 22.9 months. In 3 other patients the astigmatism gradually increased over the years, long after suture removal; two of these showed graft elevation. The study demonstrates the possible instability of keratoplasty wounds, the change in astigmatism after suture removal, and the late apparently spontaneous changes in astigmatism after PKP in some eyes.

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References

  1. Binder PS. The effect of suture removal on postkeratopasty astigmatism. Am J Ophthalmol 1988; 105: 637–45.

    Google Scholar 

  2. Binder PS. Selective suture removal can reduce postkeratoplasy astigmatism. Ophthalmology 1985; 92: 1412–16.

    Google Scholar 

  3. Musch DC, Meyer RF, Sugar A. Soong HK. Corneal astigmatism after penetrating keratoplasty. The role of suture technique. Ophthalmology 1989; 96: 698–703.

    Google Scholar 

  4. Perlman EM. An analysis and interpretation of refractive errors after penetrating keratoplasty. Ophthalmology 1981; 88: 39–45.

    Google Scholar 

  5. Bourne WM, Davidson JA, O'Fallon WM. The effects of oversize donor buttons on postoperative intraocular pressure and corneal curvature in aphakic penetrating keratoplasty. Ophthalmology 1982; 89: 242–46.

    Google Scholar 

  6. Stainer GA, Perl T, Binder PS. Controlled reduction of postkeratoplasty astigmatism. Ophthalmology 1982; 89: 668–76.

    Google Scholar 

  7. Vijvinkel G, Van Loenen Martinet AHJ. Contact keratoscope for clinical and surgical use. Int Ophthalmol 1981; 4: 177–78.

    Google Scholar 

  8. Rowsey JJ, Fowler WC, Terry MA, Scoper SV. Use of keratoscopy, slit-lamp biomicroscopy, and retinoscopy in the management of astigmatism after penetrating keratoplasty. Refract Corneal Surg 1991; 7: 33–41.

    Google Scholar 

  9. Binder PS, Abel R, Polack FM, Kaufman HE. Keratoplasty wound separations. Am J Ophthalmol 1975; 80: 109–15.

    Google Scholar 

  10. Feldman ST, Brown SI. Reduction of astigmatism after keratoplasty. Am J Ophthalmol 1987; 103: 477–8.

    Google Scholar 

  11. Burk LL, Waring III GO, Radjee B, Stulting RD. The effect of selective suture removal on astigmatism following penetrating keratoplasty. Ophthalmic Surg 1988; 19: 849–54.

    Google Scholar 

  12. Lemp MA. Cornea and sclera. Arch Ophthalmol 1976; 94: 473–90.

    Google Scholar 

  13. Lang GK, Green WR, Maumenee AE. Clinicopathologic studies of keratoplasty eyes obtained post mortem. Am J Ophthalmol 1986; 101: 28–40.

    Google Scholar 

  14. Hales RH, Spencer WH. Unsuccessful penetrating keratoplasties: Correlation of clinical and histologic findings. Arch Ophthalmol 1963; 70: 805–10.

    Google Scholar 

  15. Morrison JC, Swan KC. Descemet's membrane in penetrating keratoplasties of the human eye. Arch Ophthalmol 1983; 101: 1927–9.

    Google Scholar 

  16. Morrison JC, Swan KC. Bowman's layer in penetrating keratoplasties of the human eye. Arch Ophthalmol 1982; 100: 1835–8.

    Google Scholar 

  17. Hoppenreijs VPT, Van Rij G, Beekhuis WH, Rijneveld WJ, Rinkel-van Driel E. Long-term results of corneal wedge resections for the correction of high astigmatism. Doc Ophthalmol 1990; 75: 263–73.

    Google Scholar 

  18. Machensen G, Haug HP, Horn CH, Sundmacher R, Witschel H. Nahtlockerung nach Keratoplastiek und Korrekturmöglichkeiten. Klin Mbl Augenheilk 1978; 173: 700–7.

    Google Scholar 

  19. Van Rij G. Suture loosening and g sterilization of 10-0 nylon. Doc Ophthalmol 1979; 48: 303–7.

    Google Scholar 

  20. Balyeat HD, David RM, Rowsey JJ. Nylon suture toxicity after cataract surgery. Ophthalmology 1988; 95: 1509–14.

    Google Scholar 

  21. Aronson SB, McMaster PRB, Moore TE, Coon MA. The pathogenesis of suture toxicity. Arch Ophthalmol 1970; 84: 641–44.

    Google Scholar 

  22. Van Rij G, Waring III GO. Suture-induced astigmatism after a circular wound in the rhesus monkey. Cornea 1986; 5: 25–28.

    Google Scholar 

  23. Harris DJ, Waring III GO, Burk LL, Keratography as a guide to selective suture removal for the reduction of astigmatism after penetrating keratoplasty. Ophthalmology 1989; 96: 1597–1607.

    Google Scholar 

  24. Pallikaris I. Die präoperative Placidophotographie bei Keratokonus und ihre Bedeutung im Zusammenhang mit dem postoperativen Astigmatismus. Graefes Arch Klin Exp Ophthalmol 1980; 213: 87–99.

    Google Scholar 

  25. Musch DC, Meyer RF, Sugar A. The effect of removing running sutures on astigmatism after penetrating keratoplasty. Arch Ophthalmol 1988; 106: 488–92.

    Google Scholar 

  26. Huber C, Deseo T. The effect of keratoplasty running sutures on the shape of the cornea. Dev Ophthalmol 1985; 11: 79–85.

    Google Scholar 

  27. Lin DTC, Wilson SE, Reidy JJ, Klyce SD, McDonald MB, Kaufman HE, McNeill JI. An adjustable single running suture technique to reduce postkeratoplasty astigmatism. A preliminary report. Ophthalmology 1990; 97: 934–38.

    Google Scholar 

  28. Temnycky GO, Lindahl KH, Aquavella JV, Erdey RA. Early visual rehabilitation following keratoplasty using a single continuous adjustable suture technique. Ophthalmic Surg 1991; 22: 208–12.

    Google Scholar 

  29. McNeill JI, Wessels IF. Adjustment of single continuous suture to control astigmatism after penetrating keratoplasty. Refract Corneal Surg 1989; 5: 216–23.

    Google Scholar 

  30. Nabors G, Van der Zwaag R, Van Meter WS, Wood TO. Suture adjustment for postkeratoplasty astigmatism. Trans Am Ophthalmol Soc 1990; 88: 289–96.

    Google Scholar 

  31. Van Meter WS, Gussler JR, Soloman KD, Wood TO. Postkeratoplasty astigmatism control. Single continuous suture adjustment versus selective interrupted suture removal. Ophthalmology 1991; 98: 177–83.

    Google Scholar 

  32. Troutman RC. Astigmatic considerations in corneal graft. Ophthalmic Surg 1979; 10: 21–26.

    Google Scholar 

  33. Burk LL, Waring III GO, Harris DJ. Simultaneous and sequential selective suture removal to reduce astigmatism after penetrating keratoplasty. Refract Corneal Surg 1990; 6: 179–87.

    Google Scholar 

  34. Mathers WD, Gold JB, Kattan H, Lemp MA. Corneal steepening with final suture removal after penetrating keratoplasty. Cornea 1991; 10: 221–23.

    Google Scholar 

  35. Troutman RC, Gaster RN. Surgical advances and results of keratoconus. Am J Ophthalmol 1980; 90: 131–6.

    Google Scholar 

  36. Troutman RC. Microsurgery of the Anterior Segment of the Eye, Vol. 2. St Louis: Mosby, 1977: 7–262.

    Google Scholar 

  37. Van Rij G, Cornell FM. Waring III GO, Wilson LA, Beekhuis WH. Postoperative astigmatism after central vs eccentric penetrating keratoplasties. Am J Opthalmol 1985; 99: 317–20.

    Google Scholar 

  38. Kaufman HE. Astigmatism after keratoplasty: Possible cause and method of prevention. Am J Ophthalmol 1982; 94: 556–57.

    Google Scholar 

  39. Villacriz E, Rife L, Smith RE. Oval host wounds and postkeratoplasty astigmatism. Cornea 1987; 6: 181–84.

    Google Scholar 

  40. Van Rij G, Waring GO. Configuration of corneal trephine opening using five different trephines in human donor eyes. Arch Ophthalmol 1988; 106: 1228–33.

    Google Scholar 

  41. Mahjoub SB, Au YK. Astigmatism and tissue-shape disparity in penetrating keratoplasty. Ophthalmic Surg 1990; 21: 187–90.

    Google Scholar 

  42. Cohen KL, Holman RE, Tripoli NK, Kupper LL. Effect of trephine tilt on corneal button dimensions. AM J Ophthalmol 1986; 101: 722–25.

    Google Scholar 

  43. Olson RJ. Corneal curvature changes associated with penetrating keratoplasty: A mathematical model. Ophthalmic Surg 1980; 11: 838–42.

    Google Scholar 

  44. Olson RJ. The effect of scleral fixation ring placement and trephine tilting on keratoplasty wound size and donor shape. Ophthalmic Surg 1981; 12: 23–6.

    Google Scholar 

  45. Cohen KL, Tripoli NK, Pellom AC, Kupper LL, Fryczkowski AW. Effect of tissue fit on corneal shape after transplantation. Invest Ophthalmol Vis Sci 1984; 25: 1226–31.

    Google Scholar 

  46. Cohen KL, Tripoloi NK, Proia AD. Cat keratoplasty wound healing and corneal astigmatism. Invest Ophthalmol Vis Sci 1989; 30 (suppl); 339.

    Google Scholar 

  47. Perl T. Charlton KH, Binder PS. Disparate diameter grafting. Astigmatism, intraocular pressure, and visual acuity. Ophthalmology 1981; 88: 774–81.

    Google Scholar 

  48. Jensen AD, Maumenee AE. Refractive errors following keratoplasty. Trans Am Ophthalmol Soc 1974; 72: 123–31.

    Google Scholar 

  49. Heidemann DG, Sugar A, Meyer RF, Musch DC. Oversized donor grafts in penetrating keratoplasty: A randomized trial. Arch Ophthalmol 1985; 103: 1807–11.

    Google Scholar 

  50. Olson RJ, Mattingly TP, Waltman SR, Kaufman HE: Refractive variation and donor tissue size in aphakic keratoplasty. Arch Ophthalmol 1979; 97: 1480–81.

    Google Scholar 

  51. Meyer HJ, Cordesmeyer H. Zum postoperativen Astigmatismus nach Keratoplastik bei Keratokonus [Postoperative astigmatism after keratoplasty in keratoconus]. Fortschr Ophthalmol 1987; 84: 427–28.

    Google Scholar 

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Authors and Affiliations

  1. Department of Morphology, The Netherlands Ophthalmic Research Institute, Amsterdam, The Netherlands

    V. P. T. Hoppenreijs

  2. Department of Ophthalmology, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands

    G. Van Rij

  3. Eye Hospital, Rotterdam, The Netherlands

    W. H. Beekhuis, W. J. Rijneveld & E. Rinkel-Van Driel

Authors
  1. V. P. T. Hoppenreijs
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  2. G. Van Rij
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  3. W. H. Beekhuis
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  4. W. J. Rijneveld
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  5. E. Rinkel-Van Driel
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Hoppenreijs, V.P.T., Van Rij, G., Beekhuis, W.H. et al. Causes of high astigmatism after penetrating keratoplasty. Doc Ophthalmol 85, 21–34 (1993). https://doi.org/10.1007/BF01268097

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