Management of Extreme Ametropia after Penetrating Keratoplasty: A Series of Surgical Procedures for High Myopia and Astigmatism

Abstract

A series of surgical interventions - relaxing corneal incisions, intraocular lens, and intrastromal rings - were used to correct a case of extreme ametropia in a thin cornea after a penetrating keratoplasty in an 18-year-old patient who presented with a -10.25 -8.50 × 120 preoperative refraction and 20/200 best-corrected visual acuity (BCVA). After a series of surgical procedures, the patient's BCVA in his left eye improved to 20/30 with +0.50 -1.00 × 170, the slit lamp examination showed no significant findings, and the patient's visual complaints disappeared. At the 1-year follow-up, the BCVA was 20/25, without visual complaints. The process of individualizing the surgical procedure in the present case was employed in an outcome-based approach, that is, the next surgical procedure was defined after the surgery and postoperative evaluation. The patient did not present complications during the follow-up period of 2.5 years.

Effects of corneoconjunctival transposition, posterior lamellar keratoplasty and modified deep lamellar endothelial keratoplasty on streak retinoscopy in equine cadaver eyes

“…Of note, the human medical literature states that myopia and astigmatism are the primary refractive errors noted following penetrating keratoplasty and deep lamellar keratoplasty. [24][25][26][27] This contrasts with the hyperopia identified in this study in the CCT and PLK surgeries. However, Terry et al discuss refractive error following DLEK in humans, which appears limited, similar to our study.…”

“…21 Human medical literature has extensively evaluated postoperative refractive changes following various ophthalmic surgeries. [24][25][26][27][28] While there are several publications on retinoscopy in horses, [29][30][31][32][33][34][35][36][37][38] to the authors' knowledge, the comparison of refractive values prior to and following corneal surgery has not been documented in the equine veterinary literature. In this study, the refraction preoperatively to postoperatively will be compared for the CCT, PLK and modified DLEK.…”

Small Incision Lenticule Extraction for Postkeratoplasty Myopia and Astigmatism

“…Compared to other techniques, undercorrection and, rarely, overcorrection have also been reported for almost all corneal refractive surgical methods of correcting post-PKP myopia and astigmatism including incisional surgeries [ 12 ], photoablation (PRK or LASIK) [ 19 – 26 ], and ICR implantation [ 17 , 18 ].…”

“…Intracorneal ring segment (ICR) implantation has recently been reported in post-PKP eyes but with significant undercorrection and low predictability compared to their results in keratoconic eyes. Immune reaction induction leading to graft rejection and ring migration and perforation into the anterior chamber are possible complications that can violate the future integrity of the grafted cornea [ 1 , 17 , 18 ].…”

Refractive Use of Intrastromal Corneal Rings in Penetrating Keratoplasty

“…The patient in this case did not present a good indication to perform relaxing incisions since the procedure presents high rates of recurrence, is less predictable, and more invasive when compared to the ring implant, as we were in front of a transparent corneal graft of 10 years of implantation, we opted for a more conservative procedure with lower chances of developing an inflammatory reaction and consequently lower chances of leading to late failure [1,10].…”