The impact of tear functions on visual outcome following keratoplasty in eyes with keratoconus.

Abstract

BACKGROUND:

To investigate the impact of preoperative and postoperative tear functions on visual outcome and the recovery of visual function following keratoplasty in eyes with keratoconus.

METHODS:

Twenty-five eyes of 25 consecutive patients (5 females, 20 males, mean age: 34.3 ± 15.8 years (range: 19-70 years) with keratoconus who underwent either penetrating keratoplasty (PKP) or deep anterior lamellar keratoplasty (DALK) were included in this prospective study. One patient who had a rejection episode during the follow-up period was excluded. All subjects underwent best corrected visual acuity (BCVA), corneal topography (refractive cylinder, surface regularity index: SRI and surface asymmetry index: SAI), Schirmer I test, tear film break-up time (BUT), corneal sensitivity, and fluorescein staining score measurements before as well as 1, 3, 6 and 12 months after keratoplasty. The relation between the tear functions and the duration until the achievement of maximum BCVA was also evaluated. Linear regression analysis was performed to study the statistical significance of the correlations and the time wise change of each examined parameter.

RESULTS:

SRI, SAI, and BCVA significantly improved after keratoplasty. The postoperative corneal sensitivity was still significantly low even at 12 months postoperatively. Postoperative BCVA at 3, 6 months and maximum BCVA showed a significant linear negative correlation with the preoperative BUT (3 months; r = -0.461, p = 0.036, 6 months; r = -0.494, p = 0.023, maximum BCVA; r = -0.473, p = 0.030). The duration until the achievement of maximum BCVA showed a significant negative correlation with the preoperative Schirmer test (r = -0.429, p = 0.036). BCVA at 1 and 3 months postoperatively showed significant linear negative correlations with BUT value at the respective periods (1 month; r = -0.665, p = 0.0036, 3 months; r = -0.580, p = 0.0059).

CONCLUSION:

Preoperative tear functions appeared to have an influence on postoperative BCVA and the duration of visual recovery in keratoconus patients undergoing keratoplasty. Postoperative tear film stability appears to play an important role for obtaining a better BCVA in the early postoperative period after keratoplasty.

• Authors: Shuya Hara, Takashi Kojima, Murat Dogru, Yuichi Uchino, Eiki Goto, Yukihiro Matsumoto, Tetsuya Kawakita, Kazuo Tsubota, Jun Shimazaki
• Journal: Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie (Graefes Arch Clin Exp Ophthalmol) Vol. 251 Issue 7 Pg. 1763-70 (Jul 2013) ISSN: 1435-702X [Electronic] Germany
• PMID: 23519883 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Cornea (physiopathology)
• Corneal Topography
• Corneal Transplantation
• Female
• Fluorophotometry
• Humans
• Keratoconus (physiopathology, surgery)
• Keratoplasty, Penetrating
• Male
• Middle Aged
• Prospective Studies
• Recovery of Function
• Tears (physiology)
• Treatment Outcome
• Visual Acuity (physiology)
• Young Adult