Prediction of visual outcome after penetrating keratoplasty for pseudophakic corneal edema
Received 27 December 2001; accepted 1 October 2002.
Abstract
Objective
To evaluate the ability to predict visual outcome after penetrating keratoplasty (PKP) in patients with pseudophakic corneal edema (PCE) or aphakic corneal edema (ACE) based on preoperative parameters available from the patient history and ocular examination.
Design
Retrospective noncomparative case series.
Participants
Forty-eight patients who underwent 59 PKP procedures for PCE between 1997 and 2000 by two cornea specialists.
Methods
Medical records were retrospectively analyzed for variables in the history and ocular examination before PKP and visual outcome after PKP. Variables included age, gender, presence of diabetes or cardiovascular disease, method of intraocular lens (IOL) implantation during cataract surgery, vitreous loss during cataract surgery, time between cataract and PKP surgery, and maximal visual acuity reached after cataract surgery. The predictive value of each preoperative variable on post-PKP visual outcome was assessed using both univariate and multiple regression analyses.
Main outcome measures
Statistical significance for the predictive value of each preoperative variable on post-PKP visual outcome.
Results
Best-corrected visual acuity (BCVA) of 20/40 or better was achieved in 13 patients (27%). The strongest predictor of this outcome was implantation of a bag-fixated or sulcus-fixated IOL at the time of cataract surgery (P = 0.007; odds ratio, 15.8; 95% confidence interval, 1.2–208). Less significant variables included BCVA after cataract surgery, time between cataract surgery and PKP, and gender.
Conclusions
In planning and advising patients with pseudophakic or aphakic corneal edema who are candidates for PKP, the method of IOL implantation during the cataract surgery is the single most significant predictor of visual acuity after corneal transplantation. Bag-fixated or sulcus-fixated posterior chamber IOL was associated with a better visual outcome than anterior chamber IOL, scleral-fixated posterior chamber IOL, or aphakia.
1Department of Ophthalmology, Assaf Harofe Medical Center, Beer Yaacov, Israel
Reprint requests to Yaniv Barkana, MD, Assaf Harofe Medical Center, Beer Yaacov, Zerifin 70300 Israel.
ABSTRACT