Abstract
The success rate for penetrating keratoplasty in non‐vascularised corneas is now in the region of 95%. However corneal clarity alone can no longer be considered as the sole criteria for success, and the quality of the visual outcome is now receiving much more attention. This is often compromised by high astigmatism and topographic irregularity.A prospective longitudinal trial involving 108 eyes with transplanted corneas was carried out. The longest follow‐up was for 10 years, and data was available for 60 patients at the 5 year stage. Healing and improvement in corneal topography are dynamic processes, and it was decided to use sequential observations taken from the same eye to investigate changes in corneal topography over time. The results were then related to patient characteristics and to variables in the surgical technique, and multivariate analysis carried out to determine which factors have the most influence on the outcome.A photokeratoscope was used and an analysis technique was developed which enabled clinically meaningful topographical components to be derived from measurements of each keratograph. These components were spherical equivalent, asymmetry, axis of asymmetry, regular astigmatism and its axis, and an irregularity component. The changes in astigmatism and irregularity were analysed using Multilevel Modeling. The results of this study will be presented and the implications discussed.Computerised video‐keratoscopes are capable of revealing a great deal of information about corneal irregularity and are therefore useful in the management of post‐keratoplasty astigmatism. Colour topography maps will be presented which demonstrate commonly encountered features. These will include the effect of individual tight sutures and the changes brought about by suture removal and refractive surgery. The potential of video‐keratography as a guide to the optometrist in refraction and contact lens fitting for the post‐keratoplasty patient will be discussed.
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