Résumé
To compare intraocular pressure [IOP] readings measured by the Ocular Response Analyzer [ORA] with those measured by the Goldmann applanation tonometer [GAT] in keratoconic eyes following penetrating keratoplasty [PKP] and to evaluate the influence of anatomical and biomechanical properties of the grafts on IOP measurements. This cross-sectional study was conducted on 45 keratoconic eyes undergoing PKP. IOP was measured using the GAT [IOP GAT]; corneal hysteresis [CH], corneal resistance factor [CRF], Goldmannrelated IOP [IOPg], and cornea-compensated IOP [IOPcc] were obtained using the ORA; central graft thickness [CGT] was measured by ultrasonic pachymetry. Bland-Altman and mountain plots were used to evaluate agreement between the tonometers. The correlation of graft curvature and astigmatism; central graft thickness [CGT]; and corneal biomechanical properties with IOP readings was investigated using multivariate regression analysis. Mean patient age was 29.8 +/- 6.1 years and mean follow up was 91.2 +/- 35.4 months. Mean CH, CRF, and CGT were 10.2 +/- 2.1 mmHg, 10.1 +/- 2.2 mmHg, and 565.4 +/- 37.7 mm, respectively. Mean IOP GAT, IOPg, and IOPcc were 12.2 +/- 2.4, 15.1 +/- 3.5, and 15.8 +/- 3.3 mmHg, respectively [P<0.001]. The 95% limit of agreement between IOP GAT and IOPg ranged from -3.6 to 9.3 mmHg. CH and CRF, but not CGT or keratometric astigmatism were significantly associated with IOP GAT, IOPg, and IOPcc. Graft biomechanics had more influence on IOP values as compared to anatomical features. In comparison to GAT, the ORA seem to overestimate IOP in post-PKP eyes
Résumé
To report the outcomes of manual lamellar keratoplasty [LKP] in patients with delayed-onset mustard gas keratitis [MGK] and compare visual outcomes between subgroups with simultaneous or sequential KLAL and LKP. In this retrospective, interventional study, 52 eyes of 37 male survivors of chemical warfare with MGK who underwent LKP were included. The results were evaluated with respect to best spectaclecorrected visual acuity [BSCVA], refractive error, keratometric readings and graft clarity. Eyes with sequential versus simultaneous surgery were compared in terms of BSCVA, refraction, corneal graft surface stability, and stem cell and corneal graft survival rates. Mean patient age at the time of surgery was 43.4 +/- 8.2 [36-48] years, and mean follow-up period was 41.4 +/- 19.6 [19-107] months. Mean preoperative BSCVA was 0.51 +/- 0.48 logMAR, which increased to 0.33 +/- 0.18 logMAR [P=0.03]. Mean preoperative spherical equivalent refractive error was -2.40 +/- 1.5 diopters [D], which remained unchanged postoperatively [-1.52 +/- 3.7 D, P=0.77]. No significant difference between sequential and simultaneous surgery subgroups was observed in BSCVA, refraction, keratometry readings, or corneal graft survival [90.3% and 89.9%, respectively; P=0.68]. However, the simultaneous group had statistically better stem cell survival. LKP can effectively improve BSCVA in MGK. The simultaneous approach is superior to sequential surgery when both stem cell and corneal transplantation are indicated