Penetrating keratoplasty for keratoconus: Visual outcome and success

Objective: To determine the long-term effect on vision of penetrating keratoplasty performed for keratoconus. Design: Retrospective noncomparative case series. Participants: All patients with keratoconus who received a corneal graft and who remained in our center for follow-up and visual rehabilitation during the study period. Intervention: Penetrating keratoplasty was performed in 93 eyes of 78 patients. Main Outcome Measures: Graft survival, visual acuity, and astigmatism. Results: One (1.08%) graft failure was encountered over a mean follow-up of 46 months. Mean preoperative (best corrected) and postoperative visual acuity is (best-tolerated correction) were 0.9 (20/160) and 0.24 (20/80) logMAR, respectively. Visual acuity in 86% of eyes was 0.3 logMAR (20/40) or better at the latest follow-up, with 67% of eyes being corrected with spectacles. Mean preoperative corneal power by keratometry was more than 52 diopters (D) in 83% of eyes; mean postoperative corneal power was 45 +/- 2 D, No significant predictors of postgraft astigmatism were found, Mean preoperative and postoperative best-eye acuities of the better eye were 0.32 (20/40-1) and 0.18 (20/32+1) logMAR, respectively (P < 0.001). Conclusions: Graft survival was excellent. A corrected visual acuity of 20/40 or better was obtained in 86% of eyes. Astigmatism could not be predicted from preoperative factors, Visual acuity measured in the better eye improved by 0.14 logMAR (1.4 lines), implying an overall functional gain for the patient. Ophthalmology 2000; 107:1125-1131 (C) 2000 by the American Academy of Ophthalmology.