VISUAL RESULTS AFTER PENETRATING KERATOPLASTY FOR APHAKIC BULLOUS KERATOPATHY AND FUCHS DYSTROPHY

We studied prospectively 43 consecutive penetrating keratoplasties for uncomplicated aphakic bullous keratopathy and combined penetrating keratoplasty and cataract extraction for bullous keratopathy and Fuchs' dystrophy to determine final visual acuity and corneal graft clarity. Two eyes were excluded because of death (one patient, two eyes). Of the 43 eyes in the study, 42 (95%) had clear grafts with normal corneal thickness and no edema for a minimum follow-up of one year. One eye in the aphakic group had an irreparable retinal detachment and one graft failed. Of the 39 remaining, 27 (67%) had visual acuity of 6/24 (20/80) or better with a median visual acuity of 6/15 (20/50). Of those with visual acuity less than 6/24 (20/80), all had other pathologic findings that could explain the decreased vision. The most common problem seen was macular degeneration (visual acuity from 6/24 [20/80] to 6/60 [20/200]. The next most common problem was cystoid macular edema, clinically significant in six eyes with aphakic bullous keratopathy and in none with Fuchs' dystrophy. Combined graft and cataract extraction in aphakic eyes resulted in significantly more cystoid macular edema (P = .009). The remaining three eyes with poor vision all had severe glaucoma during the first postoperative week with no previous history of glaucoma and a final visual acuity of counting fingers with a clear graft and pale disks. All three eyes had received donor tissue the same size as the recipient opening; no eyes receiving donor tissue 0.5 mm larger than the recipient opening had this complication. Excellent visual acuity with no other complications was seen significantly more frequently as a result of the combined procedure than as a result of penetrating keratoplasty in aphakic bullous keratopathy (P = .002). © 1979.