Irregular Astigmatism After Corneal Transplantation--Efficacy and Safety of Topography-Guided Treatment.
OBJECTIVE
To analyze the efficacy and safety of topography-guided photorefractive keratectomy (TG-PRK) to treat irregular astigmatism after corneal transplantation.


METHODS
This was a retrospective observational case series. Eyes with irregular astigmatism after penetrating keratoplasty treated with TG-PRK (Allegretto Wave Eye-Q) with the topography-guided customized ablation treatment protocol were included. All treatments had been planned to correct the topographic irregularities, as well as to reduce the refractive error after neutralizing the induced refractive change. Clinical records, treatment plan, and the examinations performed were reviewed and the following data were collected: corrected and uncorrected distance visual acuities; manifest refraction; topographic parameters, and corneal endothelial cell count.


RESULTS
We included 31 eyes [30 patients; mean age 45.0 ± 13.4 (SD) years]. At the last postoperative follow-up (mean 9.2 ± 8.2 months), we observed a significant improvement in corrected (P = 0.001) and uncorrected distance visual acuities (P < 0.001). There was a gain of ≥1 uncorrected distance visual acuity line in 96.8% (n = 30) of the eyes. Similarly, the refractive parameters also improved (cylinder P < 0.001; spherical equivalent P = 0.002). At the last visit, 54.8% (n = 17) of the patients presented a spherical equivalent of ±1 D. The 3-mm topographic irregularity also decreased significantly (P < 0.001). There was no significant variation of the corneal endothelial cell count.


CONCLUSIONS
This is the largest case series of TG-PRK to treat irregular astigmatism in postcorneal transplantation eyes. Our results confirm that TG-PRK is an efficient treatment, associated with significant improvements of both visual acuity and refractive parameters.
*Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; †Faculty of Medicine, University of Coimbra, Coimbra, Portugal; and ‡Visual Neuroscience Laboratory, CNC.IBILI, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Inês
I
Laíns
Andreia M
AM
Rosa
Marta
M
Guerra
Cristina
C
Tavares
Conceição
C
Lobo
Maria F L
MF
Silva
Maria J
MJ
Quadrado
Joaquim N
JN
Murta
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001251:Astigmatism / Q000473:pathology / Q000628:therapy*; D003315:Cornea / Q000473:pathology* / Q000601:surgery; D019781:Corneal Topography / Q000379:methods*; D016039:Corneal Transplantation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018903:Photorefractive Keratectomy / Q000379:methods*; D011183:Postoperative Complications; D012029:Refraction, Ocular / Q000502:physiology*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult