Astigmatism after penetrating keratoplasty using the Krumeich guided trephine system.

BACKGROUND: The use of a suction trephine during penetrating keratoplasty has the potential to reduce trephination errors and astigmatism after suture removal. METHODS: In this study, we evaluated refractive astigmatism after suture removal in 26 eyes that had penetrating keratoplasty for keratoconus using refraction, keratometry, and videokeratography. Group I (11 eyes) had manual trephination with an open disposable blade of both the donor (8.2 mm) and the recipient (8.0 mm). Group II (10 eyes) had manual trephination with an open disposable blade of the donor (8.2 mm) and Krumeich guided trephine system trephination of the recipient (8.0 mm). Group III (5 eyes) had guided trephination of both the donor (8.0 mm) and the recipient (8.0 mm). RESULTS: The guided trephine groups II and III demonstrated statistically significant less refractive cylinder when compared to manual trephination group I (p < .01). The mean keratometric cylinder for group I was 6.50 diopters (D) (range, 1.50 to 9.00 D), for group II was 3.00 D (range, 0.50 to 7.00 D), and for group III was 2.55 D (range, 0 to 4.00 D). CONCLUSION: The Krumeich guided trephine system produced less keratometric astigmatism than manual trephination after penetrating keratoplasty for keratoconus.

Long-term maintenance of reduced intraocular pressure by daily or twice daily topical application of prostaglandins to cat or rhesus monkey eyes.

Substantial evidence indicates that a single topical application of prostaglandins (PGs) can reduce intraocular pressure (IOP) in the eyes of several species. However, earlier literature, dealing with ocular hypertensive and inflammatory responses, shows the development of tachyphylaxis to subsequent doses of PGs. If similar tolerance developed to the ocular hypotensive effects of PGs, it would preclude the use of these agents in the treatment of chronic glaucoma. The present study shows, however, that although tachyphylaxis to the ocular hypotensive effects of PGs develops in rabbits, this is not a typical response among mammals. Significant IOP reduction was maintained in cats for up to 9 months by topical application of PGE2 at 12-, 24-, or 48-hr intervals. The IOP reduction was jeopardized seriously only when the PG was applied every other day for several days or when, on a few occasions, 3 days were allowed to elapse between PGE2 applications. Ocular hypotension was also maintained during the course of topical treatment of rhesus monkey eyes with PGF2 alpha. Short periods of pupillary constriction followed the application of each dose of PGF2 alpha to cat eyes, but the miotic response of rhesus monkeys to PGF2 alpha and cats to PGF2 was negligible. Other apparent side effects were noted, but none of these were severe or progressive. These results clearly demonstrate that tachyphylaxis, or tolerance, is not expected to present an obstacle to the development of eicosanoids and/or their derivatives as therapeutic agents for the long-term treatment of ocular hypertension and chronic glaucoma.