ABSTRACT
PURPOSE: To evaluate the choroidal structure in patients with inherited retinal diseases (IRDs) by investigating the choroidal vascularity index (CVI). METHODS: The present study was conducted on 113 IRD patients and 113 sex- and age-matched healthy individuals. Patients' data was extracted from the Iranian National Registry for IRDs (IRDReg®). Total choroidal area (TCA) was determined between retinal pigment epithelium and choroid-scleral junction,1500 microns on either side of the fovea. Luminal area (LA) was considered as the black area corresponding to the choroidal vascular spaces, following Niblack binarization. CVI was calculated as the ratio of the LA to the TCA. CVI and other parameters were compared among different types of IRD and the control group. RESULTS: The IRD diagnosis included retinitis pigmentosa (n = 69), cone-rod dystrophy (n = 15), Usher syndrome (n = 15), Leber congenital amaurosis (n = 9), and Stargardt disease (n = 5). Sixty-one (54.0%) individuals of each of the study and control groups were male. The average CVI was 0.65 ± 0.06 in the IRD patients and 0.70 ± 0.06 in the control group (P < 0.001). Accordingly, the average of TCA and LA were 2.32 ± 0.63 and 1.52 ± 0.44 mm [1] in patients with IRDs, respectively. The measurements for the TCA and the LA were significantly lower in all subtypes of IRD (P-values < 0.05). CONCLUSION: CVI is significantly lower in patients with IRD than in healthy age-matched individuals. Choroidal changes in IRDs may be related to the changes in the lumen of the choroidal vessels rather than the stromal changes.
ABSTRACT
PURPOSE: To compare visual acuity, refractive error, and complications after penetrating keratoplasty (PK) vs deep anterior lamellar keratoplasty (DALK) in the management of advanced stage of keratoconus. DESIGN: Retrospective, comparative, interventional study. METHODS: This study enrolled 411 consecutive keratoconus eyes with preoperative mean keratometry ≥60 diopters (D) that received either PK (218 eyes) or DALK (193 eyes). The outcome measures were postoperative visual acuity, refraction, complications, and further surgical interventions. RESULTS: The mean follow-up duration was 77.9±46.5 and 72.9±47.8 months in the PK and DALK groups, respectively (P = .28). Compared with baseline values, postoperative visual acuity and refraction significantly improved in both groups. Postoperative corrected distance visual acuity was 0.18±0.13 and 0.26±0.19 logMAR in the PK and DALK groups, respectively (P < .001). Postoperative spherical equivalent refraction was -2.89±2.89 D after PK and -4.58±3.62 D after DALK (P < .001). Final keratometric astigmatism was comparable between the 2 groups (P = .82). Suture-related complications were observed in 48.6% of the PK eyes and 72.0% of the DALK eyes (P < .001). The incidence of graft rejection was 33.5% after PK and 19.7% after DALK (P = .002). At the last visit, 98.2% of PK grafts and 94.8% of DALK grafts remained clear (P = .06). CONCLUSION: Both techniques of corneal transplantation led to a significant improvement in the visual and refractive variables in eyes with advanced keratoconus. PK resulted in a better visual acuity and refraction with less suture-related complications compared to DALK. However, PK was associated with a higher rate of graft rejection. The 2 techniques were comparable in terms of graft survival.
