Abstract

SO.06.07

Homologous penetrating central limbokeratoplasty versus conventional homologous penetrating keratoplasty and hard contact lens in granular and lattice corneal dystrophy

Vandemeulebroecke N., Spelsberg H.
Department of Ophthalmology, Heinrich-Heine-University Düsseldorf

Objective: After conventional penetrating keratoplasty, recurrences are frequently observed in granular and lattice corneal dystrophy. Homologous penetrating central limbokeratoplasty was introduced to avoid recurrences, but did not fullfill the expectations. Soft contact lenses are reported to have a positive effect to maintain a clear graft after keratoplasty (Roters et al., 2004). The aim of this prospective study is to investigate whether recurrences of the dystrophy can be avoided by fitting a hard contact lens after removal of all sutures in conventional penetrating keratoplasty. These results are compared with the experiences with limbokeratoplasty.
Methods: In 33 eyes from 28 patients with granular or lattice dystrophy limbokeratoplasty was performed between 1995 and 2003. Since 2003 twenty-seven eyes with lattice or granular dystrophy underwent conventional penetrating keratoplasty. Seven of them (26%) were treated with a fitted hard contact lens after removal of all sutures 18 months postoperatively. Contact lens fitting was not successful in 20 of 27 eyes (74%) due to advanced age, handling problems or surface disorders.
Results: Six recurrences were observed in 33 eyes after limbokeratoplasty with a mean follow-up time of 27 months (1-58 months). None of the seven eyes with a fitted contact lens after conventional keratoplasty, presented signs of recurrence after a mean follow-up time of 36 months postoperatively (20-47 months).
Conclusions: Wearing a hard contact lens after penetrating keratoplasty seems to avoid or minimize recurrences of a granular or lattice dystrophy. Despite the short follow-up time these results are encouraging to find good fitting solutions in more patients after conventional keratoplasty. Further observations will be presented later.

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