title: Topography-guided conductive keratoplasty: treatment for advanced keratoconus.
abstract: OBJECTIVE
  To evaluate the use of topography-guided conductive keratoplasty in eyes with keratoconus.
  
  
  METHODS
  Interventional case series.
  
  
  METHODS
  We examined 21 eyes in 21 patients with advanced keratoconus. Topography-guided conductive keratoplasty was performed with intraoperative monitoring of corneal astigmatism using a surgical keratometer. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), corneal topography, manifest refraction, intraocular pressure (IOP), corneal endothelial cell counts, complications, and eventual outcomes were evaluated.
  
  
  RESULTS
  UCVA (logarithm of the minimal angle of resolution [logMAR]), which was 1.65 ± 0.49 preoperatively, improved to 1.04 ± 0.64 at 1 week (P < .001) and 1.12 ± 0.61 at 1 month after surgery (P < .001). BSCVA, which was 1.02 ± 0.56 preoperatively, improved to 0.76 ± 0.65 at 1 week (P = .026) and 0.76 ± 0.60 at 1 month after surgery (P = .003). Manifest refraction, which was -15.13 ± 6.66 diopters (D) before surgery, declined to -9.97 ± 6.71 D at 1 month after surgery (P = .002). Although corneal topography reverted to the preoperative pattern and UCVA and BSCVA also regressed toward preoperative values, 12 of 21 eyes were better able to tolerate and conduct normal daily activities using contact lenses. Five subjects have undergone or are considering corneal transplantation after unsatisfactory postoperative results. No serious perioperative complication was observed.
  
  
  CONCLUSIONS
  Topography-guided conductive keratoplasty may be effective in reshaping corneal configuration in eyes with keratoconus, without serious complications, and possibly contributed to avoiding or delaying corneal transplantation.
authors.affiliation: Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan. naokato@sc.itc.keio.ac.jp
authors.forename: Naoko
authors.initials: N
authors.lastname: Kato
authors.forename: Ikuko
authors.initials: I
authors.lastname: Toda
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kawakita
authors.forename: Chikako
authors.initials: C
authors.lastname: Sakai
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tsubota
mesh_terms: D000293:Adolescent; D000328:Adult; D001251:Astigmatism / Q000517:prevention & control; D017115:Catheter Ablation / Q000379:methods*; D002452:Cell Count; D003261:Contact Lenses / Q000706:statistics & numerical data; D003319:Corneal Stroma / Q000503:physiopathology / Q000601:surgery*; D019781:Corneal Topography; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D007431:Intraoperative Complications; D007640:Keratoconus / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D011183:Postoperative Complications; D012029:Refraction, Ocular / Q000502:physiology; D012086:Reoperation; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult