Intraoperative Videokeratography in Penetrating Keratoplasty and Excimer Laser-assisted Lamellar Keratoplasty for Keratoconus

PURPOSE: To evaluate the usefulness of intraoperative computerized corneal topographic data in excimer laser-assisted lamellar keratoplasty (ELLK) and penetrating keratoplasty (PK). METHODS: Prospective, comparative, interventional case series. Intra-and postoperative videokeratography (Keratron Scout) evaluation was performed on 30 eyes of 30 consecutive patients affected by keratoconus (16 men and 14 women; mean age 32.63 +/- 8.02 years) submitted to ELLK (15 eyes) using 16 interrupted 10-0 nylon stitches or to PK (15 eyes) using a 12-bite 10-0 nylon double-running continuous suture. RESULTS: In the ELLK group, the mean intraoperative keratometric astigmatism was 12.06 +/- 4.86 diopters (D), which changed to 5.19 +/- 2.51 D after topography-guided intraoperative suture adjustment. In the PK group, intraoperative keratometric astigmatism was 10.18 +/- 3.88 D, which changed to 3.49 +/- 0.41 D. After 24 months (sutures out), the mean videokeratographic keratometric astigmatism was 3.35 +/- 1.96 D in the ELLK group and 3.37 +/- 0.92 D in the PK group. The Alpins method of vector analysis showed some significant changes especially in the ELLK group. CONCLUSIONS: In keratoplasty surgery, videokeratography is useful for suture adjustment. In the PK group, using a double-running suture technique, the postoperative astigmatism (after all sutures were removed) was similar to the astigmatism measured intraoperatively by videokeratography. [J Refract Surg. 2010; 26(9): 660-668.] doi:10.3928/1081597X-20091111-02