Post Penetrating Keratoplasty Ectasia: Incidence, Risk Factors, Clinical Features, and Treatment Options
BACKGROUND: Corneal transplantation in keratoconus (KC) patients is generally considered to be successful with a high grade of patient satisfaction. Long-term studies suggest a 6% to 11% probability of KC recurrence manifested by keratometric instability and progressive corneal ectasia. METHODS: We...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-05-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/10/2678 |
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| author | Antonio Moramarco Lorenzo Gardini Danilo Iannetta Piera Versura Luigi Fontana |
| author_facet | Antonio Moramarco Lorenzo Gardini Danilo Iannetta Piera Versura Luigi Fontana |
| author_sort | Antonio Moramarco |
| collection | DOAJ |
| description | BACKGROUND: Corneal transplantation in keratoconus (KC) patients is generally considered to be successful with a high grade of patient satisfaction. Long-term studies suggest a 6% to 11% probability of KC recurrence manifested by keratometric instability and progressive corneal ectasia. METHODS: We propose to review the frequency, risk factors for the development, and the surgical options for the correction of high irregular astigmatism due to late graft ectasia following penetrating keratoplasty (PK). RESULTS: Post-keratoplasty ectasia is characterized by increasing corneal steepening with myopic shift and high irregular astigmatism, developing years or decades after PK, mostly occurring in KC patients. Contact lenses may adequately improve the visual acuity; however, because these patients are often elderly and intolerant to hard contact lenses, ultimately a surgical correction is proposed to the patient. Compressive suture and corneal wedge resection may improve corneal astigmatism, but the outcomes are unpredictable and often temporary. For this reason, a larger PK graft is often proposed for surgical rehabilitation with the consequence of removing more of the recipient’s healthy endothelium and exposing the patient to a renewed immunogenic stimulus and short-term graft failure for endothelial decompensation. More recently, lamellar keratoplasty using various techniques has been proposed as an alternative to PK in order to maximize the visual outcomes and minimize the complications. CONCLUSIONS: Management of advanced corneal ectasia is a significant challenge for corneal surgeons. Many surgical approaches have been developed, so there is a large arsenal of surgical operations to correct post-PK ectasia. Among them, large-diameter anterior lamellar keratoplasty may be a viable, safer, and effective alternative to PK for the correction of post-keratoplasty ectasia. |
| first_indexed | 2024-03-10T03:40:09Z |
| format | Article |
| id | doaj.art-01a435051ed141abbf5df9a1fea23eeb |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T03:40:09Z |
| publishDate | 2022-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-01a435051ed141abbf5df9a1fea23eeb2023-11-23T11:33:07ZengMDPI AGJournal of Clinical Medicine2077-03832022-05-011110267810.3390/jcm11102678Post Penetrating Keratoplasty Ectasia: Incidence, Risk Factors, Clinical Features, and Treatment OptionsAntonio Moramarco0Lorenzo Gardini1Danilo Iannetta2Piera Versura3Luigi Fontana4IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Palagi 9, 40139 Bologna, ItalyIRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Palagi 9, 40139 Bologna, ItalyIRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Palagi 9, 40139 Bologna, ItalyIRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Palagi 9, 40139 Bologna, ItalyIRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Palagi 9, 40139 Bologna, ItalyBACKGROUND: Corneal transplantation in keratoconus (KC) patients is generally considered to be successful with a high grade of patient satisfaction. Long-term studies suggest a 6% to 11% probability of KC recurrence manifested by keratometric instability and progressive corneal ectasia. METHODS: We propose to review the frequency, risk factors for the development, and the surgical options for the correction of high irregular astigmatism due to late graft ectasia following penetrating keratoplasty (PK). RESULTS: Post-keratoplasty ectasia is characterized by increasing corneal steepening with myopic shift and high irregular astigmatism, developing years or decades after PK, mostly occurring in KC patients. Contact lenses may adequately improve the visual acuity; however, because these patients are often elderly and intolerant to hard contact lenses, ultimately a surgical correction is proposed to the patient. Compressive suture and corneal wedge resection may improve corneal astigmatism, but the outcomes are unpredictable and often temporary. For this reason, a larger PK graft is often proposed for surgical rehabilitation with the consequence of removing more of the recipient’s healthy endothelium and exposing the patient to a renewed immunogenic stimulus and short-term graft failure for endothelial decompensation. More recently, lamellar keratoplasty using various techniques has been proposed as an alternative to PK in order to maximize the visual outcomes and minimize the complications. CONCLUSIONS: Management of advanced corneal ectasia is a significant challenge for corneal surgeons. Many surgical approaches have been developed, so there is a large arsenal of surgical operations to correct post-PK ectasia. Among them, large-diameter anterior lamellar keratoplasty may be a viable, safer, and effective alternative to PK for the correction of post-keratoplasty ectasia.https://www.mdpi.com/2077-0383/11/10/2678corneal transplantationkeratoplastycorneal ectasiakeratoconus surgerytopographyastigmatism correction |
| spellingShingle | Antonio Moramarco Lorenzo Gardini Danilo Iannetta Piera Versura Luigi Fontana Post Penetrating Keratoplasty Ectasia: Incidence, Risk Factors, Clinical Features, and Treatment Options Journal of Clinical Medicine corneal transplantation keratoplasty corneal ectasia keratoconus surgery topography astigmatism correction |
| title | Post Penetrating Keratoplasty Ectasia: Incidence, Risk Factors, Clinical Features, and Treatment Options |
| title_full | Post Penetrating Keratoplasty Ectasia: Incidence, Risk Factors, Clinical Features, and Treatment Options |
| title_fullStr | Post Penetrating Keratoplasty Ectasia: Incidence, Risk Factors, Clinical Features, and Treatment Options |
| title_full_unstemmed | Post Penetrating Keratoplasty Ectasia: Incidence, Risk Factors, Clinical Features, and Treatment Options |
| title_short | Post Penetrating Keratoplasty Ectasia: Incidence, Risk Factors, Clinical Features, and Treatment Options |
| title_sort | post penetrating keratoplasty ectasia incidence risk factors clinical features and treatment options |
| topic | corneal transplantation keratoplasty corneal ectasia keratoconus surgery topography astigmatism correction |
| url | https://www.mdpi.com/2077-0383/11/10/2678 |
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