Abstract

DO.17.07

Penetrating keratoplasty in keratoconus

Reinhard T.
Universitäts-Augenklinik Freiburg

Glasses, contact lenses, cross-linking and Intacs have been attempted for rehabilitation of patients with moderate keratoconus. Deep anterior lamellar keratoplasty (DALK) and especially penetrating keratoplasty (kp) are reserved to advanced keratoconus. If central kp is possible in keratoconus, more than 95% of the grafts are clear 5 years postoperatively and less than 15% experience immune reactions in that period of time. This excellent prognosis (the best among all indications for kp), possibly, is due to high TGF-b₂-levels in the anterior chamber. Relative annual endothelial cell loss averages 14% and is statistically significantly lower than in all other indication groups. Possibly, this is due to a low migration tendency of the graft endothelium that gets into contact with (almost) healthy host endothelium. Visual acuity averages about 0.8 in the long run, and - regarding the literature, probably, is better than following DALK. In spite of these excellent long-term data, repeat keratoplasty will become necessary in many keratoconus patients because of the development of “keratoconus recurrences”. In summary, in advanced keratoconus kp has an excellent prognosis and, still is the gold standard.

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