The Regularity of Laser Keratectomy Depth in Nonmechanical Trephination for Penetrating Keratoplasty

Abstract

To study the regularity of laser keratectomy depth in nonmechanical trephination for penetrating keratoplasty (PK) and to assess its implications on astigmatism and visual acuity (VA). In this retrospective clinicopathologic study, the authors enrolled 26 women and 32 men (mean age 54 +/- 20 years) with either keratoconus (n = 27) or Fuchs' dystrophy (n = 31), who underwent excimer laser (193 nm) trephination using a manually guided beam. Donor cornea trephination was performed using an artificial anterior chamber and either an automated rotation device (n = 27) or a manually guided beam (n = 31). The minimum residual corneal thickness (MRCT) and the random residual corneal thickness (RRCT), requiring division with scissors in excised patient buttons or corneoscleral donor rims, were assessed in a masked fashion using histologic sections. The postkeratoplasty keratometric net astigmatism, the subjective cylinder, and the VA were evaluated before and after suture removal. In patients with keratoconus, the mean MRCT (13% +/- 14%) and RRCT (38% +/- 20%) were significantly higher than in the patients with Fuchs' dystrophy (7% +/- 11% and 26% +/- 15%, respectively) (P < .01). When an automated rotation device for trephination of the donor cornea was used, the mean MRCT (2% +/- 4%) and RRCT (14% +/- 11%) were significantly smaller than when a manually guided laser beam was employed (15% +/- 12% and 38% +/- 15%, respectively) (P < .001). After suture removal, the VA increased significantly with automated trephination (P = .04), but not with manually guided trephination of the donor cornea (P = .24). However, after a mean follow-up of 30 +/- 8 months, the differences in the mean keratometric astigmatism, refractive cylinder, and VA after automated trephination (3.0 D, 2.6 D, 20/29, respectively) compared with those after manually guided trephination of the donor cornea (4.3 D, 3.9 D, 20/33, respectively) did not reach statistical significance. The regularity of donor trephination depth can be significantly improved by using an automated rotation device instead of a manually guided beam. Although residual postkeratoplasty astigmatism was not directly related to trephination depth, the improvement of the functional results after suture removal seems to be promoted by automated trephination.