Skip to main content
SpringerLink
Log in

Keratoplasty

  • Chapter
  • First Online:
Corneal Topography

  • 908 Accesses

Abstract

Transplantation of corneal tissue can have relatively little effect on corneal shape when the layers removed and replaced are thin but can have more profound effects when thicker or even full-thickness.

Corneal steepening can result from tissue compression by tight sutures or tissue contraction as a result of cautery or scarring. Corneal flattening can result from suture loosening or the graft over-riding the host. Irregular astigmatism can result from a combination of focal changes at different sites or a torsional effect from horizontal wound misalignment.

After keratoplasty, topography may be prolate if steep centrally, oblate if flat centrally or mixed. In astigmatism, the ends of the bow ties tend to be flattened due to the graft-host junction and may be of different sizes or at an angle in asymmetric astigmatism. Irregular astigmatism may have a variety of patterns including steep/flat, horseshoe or trefoil.

In all types of anterior segment surgery, incisions have greater effect if they are longer, deeper, more vertical and nearer the centre of the cornea. Wound misalignment, either horizontally or vertically, can cause irregular astigmatism. Sutures should be sufficiently long, deep and perpendicular to the wound (radial in the case of a keratoplasty) to support the tissues in the appropriate shape.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

*References Particularly Worth Reading

  1. *Swinger CA. Postoperative astigmatism. Surv Ophthalmol. 1987;31:219–48.

    Article  CAS  Google Scholar 

  2. *van Rij G, Waring GO III. Changes in corneal curvature induced by sutures and incisions. Am J Ophthalmol. 1984;98:773–83.

    Article  Google Scholar 

  3. Minkovitz JB, Stark WJ. Corneal complications of intraocular surgery. Curr Opin Ophthalmol. 1995;6:79–85.

    Article  CAS  Google Scholar 

  4. Koch DD, Haft EA, Gay C. Computerized videokeratographic analysis of corneal topographic changes induced by sutured and unsutured 4mm scleral pocket incisions. J Cataract Refract Surg. 1993;19(Suppl):166–9.

    Article  Google Scholar 

  5. Eve FR, Troutman RC. Placement of sutures used in corneal incisions. Am J Ophthalmol. 1976;82:786–9.

    Article  CAS  Google Scholar 

  6. Stainer GA, Binder PS, Parker WT, Perl T. The natural and modified course of postcataract astigmatism. Ophthalmic Surg. 1982;13:822–7.

    CAS  PubMed  Google Scholar 

  7. Geggel HS. Effect of peripheral subepithelial fibrosis on corneal transplant topography. J Cataract Refract Surg. 1996;22:135–8.

    Article  CAS  Google Scholar 

  8. Martin RG, Sanders DR, Miller JD, Cox CC, Ballew C. Effect of cataract wound incision size on acute changes in corneal topography. J Cataract Refract Surg. 1993;19(Suppl):170–7.

    Article  Google Scholar 

  9. Iliff CE, Khodadoust A. Control of astigmatism in cataract surgery. Am J Ophthalmol. 1968;65:378–82.

    Article  CAS  Google Scholar 

  10. *Tripoli NK, Ibrahim OS, Coggins JM, et al. Quantitative and qualitative topography classification of clear penetrating keratopathies. Invest Ophthalmol Vis Sci. 1990;30(Suppl):480.

    Google Scholar 

  11. *Karabatsas CH, Cook S, Sparrow JM. A proposed classification for topographic patterns seen after penetrating keratoplasty. Br J Ophthalmol. 1999;83(4):403–9.

    Article  CAS  Google Scholar 

  12. Price NC, Steele AD. The correction of post-keratoplasty astigmatism. Eye. 1987;1:562–6.

    Article  Google Scholar 

  13. Williams KA, Roder D, Esterman A, et al. Factors predictive of corneal graft survival: report from the Australian corneal graft registry. Ophthalmology. 1992;99(3):403–14.

    Article  CAS  Google Scholar 

  14. Olson RJ, Pingree M, Ridges R, et al. Penetrating keratoplasty for keratoconus: a long-term review of results and complications. J Cataract Refract Surg. 2000;26(7):987–91.

    Article  CAS  Google Scholar 

  15. Williams KA, Hornsby NB, Bartlett CM, et al. Report from the Australian corneal graft registry. Adelaide: Tech. Rep., Snap Printing; 2004.

    Google Scholar 

  16. Javadi MA, Motlagh BF, Jafarinasab MR, et al. Outcomes of penetrating keratoplasty in keratoconus. Cornea. 2005;24(8):941–6.

    Article  Google Scholar 

  17. Troutman RC, Swinger CA. Relaxing incision for control of postoperative astigmatism following keratoplasty. Ophthalmic Surg. 1980;90:131–6.

    CAS  Google Scholar 

  18. Troutman RC, Gaster RN. Surgical advances and results of keratoconus. Am J Ophthalmol. 1980;90:131–6.

    Article  CAS  Google Scholar 

  19. Chow SP, Hopkinson CL, Tole DT, et al. Stability of visual outcome between 2 and 5 years following corneal transplantation in the United Kingdom. Br J Ophthalmol. 2018;102(1):37–41.

    Article  Google Scholar 

  20. Kwitko S, Garbus JJ, Hwang DG, Gauderman WJ, McDonnell PJ. Computer-assisted study of diurnal variation in corneal topography after penetrating keratoplasty. Ophthalmic Surg. 1992;23:10–6.

    CAS  PubMed  Google Scholar 

  21. *Khong AM, Mannis MJ, Plotnik RD, Johnson CA. Computerised topographic analysis of the healing graft after penetrating keratoplasty for keratoconus. Am J Ophthalmol. 1993;115:209–15.

    Article  CAS  Google Scholar 

  22. *Chern KC, Meiser DM, Wilson SE, Macsai MS, Krasney RH. Small-diameter, round, eccentric penetrating keratoplasties and corneal topographic correlation. Ophthalmology. 1997;104:643–7.

    Article  CAS  Google Scholar 

  23. Girard LJ, Rodriguez J, Mailman ML. Reducing surgically induced astigmatism by using a scleral tunnel. Am J Ophthalmol. 1984;97:450–6.

    Article  CAS  Google Scholar 

  24. Nielsen PJ. Prospective evaluation of surgically induced astigmatism and astigmatic keratotomy effects of various self-sealing small incisions. J Cataract Refract Surg. 1995;21:43–8.

    Article  CAS  Google Scholar 

  25. Kohnen T. Corneal shape changes and astigmatic aspects of scleral and corneal tunnel incisions [editorial]. J Cataract Refract Surg. 1997;23:301–2.

    Article  CAS  Google Scholar 

  26. Oshika T, Tsuboi S, Yaguchi S, Yoshitomi F, Nagamoto T, Nagahara K, Emi K. Comparative study of intraocular lens implantation through 3.2 and 5.5mm incisions. Ophthalmology. 1994;101:1183–90.

    Article  CAS  Google Scholar 

  27. *Levy JH, Pisacano AM, Chadwick K. Astigmatic changes after cataract surgery with 5.1mm and 3.5mm sutureless incisions. J Cataract Refract Surg. 1994;20:630–3.

    Article  CAS  Google Scholar 

  28. *Hayashi K, Hayashi H, Nakao F, Hayashi F. The correlation between incision size and corneal shape changes in sutureless cataract surgery. Ophthalmology. 1995;102:550–6.

    Article  CAS  Google Scholar 

  29. Kohnen T, Dick B, Jacobi KW. Comparison of the induced astigmatism after temporal clear corneal tunnel incisions of different sizes. J Cataract Refract Surg. 1995;21:417–24.

    Article  CAS  Google Scholar 

  30. Storr-Paulsen A, Henning V. Long-term astigmatic changes after phacoemulsification with single stitch, horizontal suture closure. J Cataract Refract Surg. 1995;21:429–32.

    Article  CAS  Google Scholar 

  31. Long DA, Monica ML. A prospective evaluation of corneal curvature changes with 3.0- to 3.5-mm corneal tunnel phacoemulsification. Ophthalmology. 1996;103:226–32.

    Article  CAS  Google Scholar 

  32. Vass C, Menapace R, Amon M, Hirsch U, Yousef A. Batch-by-batch analysis of topographic changes induced by sutured and sutureless clear corneal incisions. J Cataract Refract Surg. 1996;22:324–30.

    Article  CAS  Google Scholar 

  33. Ernest PH. Corneal lip tunnel incision. J Cataract Refract Surg. 1994;20:154–7.

    Article  CAS  Google Scholar 

  34. Vass C, Menapace R, Rainer G. Corneal topographic changes after frown and straight sclerocorneal incisions. J Cataract Refract Surg. 1997;23:913–22.

    Article  CAS  Google Scholar 

  35. Filatov V, Alexandrakis G, Talamo JH, Steinert RF. Comparison of suture-in and suture-out postkeratoplasty astigmatism with single running suture or combined running and interrupted sutures. Am J Ophthalmol. 1996;122:696–700.

    Article  CAS  Google Scholar 

  36. Gorn RA. Surgically induced corneal astigmatism and its spontaneous regression. Ophthalmic Surg. 1985;16:162–4.

    CAS  PubMed  Google Scholar 

  37. Singh D, Kumar K. Keratometric changes after cataract extraction. Br J Ophthalmol. 1976;60:638–41.

    Article  CAS  Google Scholar 

  38. Dowling JL. Wound closure in cataract surgery. Ophthalmic Surg. 1981;12:574–7.

    PubMed  Google Scholar 

  39. Floyd G. Changes in the corneal curvature following cataract surgery. Am J Ophthalmol. 1951;34:1525–33.

    Article  CAS  Google Scholar 

  40. Jaffe NS, Clayman HM. The pathophysiology of corneal astigmatism after cataract extraction. Trans Am Acad Ophthalmol Otolaryngol. 1975;79:615–30.

    Google Scholar 

  41. Wishart MS, Wishart PK, Gregor ZJ. Corneal astigmatism following cataract extraction. Br J Ophthalmol. 1986;70:825–30.

    Article  CAS  Google Scholar 

  42. Kondrot EC. Keratometric cylinder and visual recovery following phacoemulsification and intraocular lens implantation using a self-sealing cataract incision. J Cataract Refract Surg. 1991;17(Suppl):731–3.

    Article  Google Scholar 

  43. Talamo JH, Stark WJ, Gottsch JD, Goodman DF, Pratzer K, Cravy TV, Enger C. Natural history of corneal astigmatism after cataract surgery. J Cataract Refract Surg. 1991;17:313–8.

    Article  CAS  Google Scholar 

  44. O’Driscoll AM, Goble RR, Hallack GN, Andrew NC. A prospective, controlled study of a 9/0 elastic polypropylene suture for cataract surgery: refractive results and complications. Eye. 1994;8:538–42.

    Article  Google Scholar 

  45. Drews RC. Astigmatism after cataract surgery: nylon versus mersilene. J Cataract Refract Surg. 1995;21:70–2.

    Article  CAS  Google Scholar 

  46. Serarevic ON, Renard GJ, Pouliquen Y. Randomised clinical trial comparing astigmatism and visual rehabilitation after penetrating keratoplasty with and without intraoperative suture adjustment. Ophthalmology. 1994;106:990–9.

    Article  Google Scholar 

  47. Samples JR, Binder PS. The value of the Terry Keratometer in predicting postoperative astigmatism. Ophthalmology. 1984;91:280–4.

    Article  CAS  Google Scholar 

  48. Morlet N. Clinical utility of the Barrett keratoscope with astigmatic dial. Ophthalmic Surg. 1994;25:150–3.

    CAS  Google Scholar 

  49. Thall EH, Lange SR. Preliminary results of a new intraoperative corneal topography technique. J Cataract Refract Surg. 1993;19(Suppl):193–7.

    Article  Google Scholar 

  50. *Frantz JM, Reidy JJ, McDonald, MB. A comparison of surgical keratometers. Refract Corneal Surg. 1989;5:409–13.

    Google Scholar 

  51. *Maguire LJ, Bourne WM. Corneal topography of transverse keratotomies for astigmatism after penetrating keratoplasty. Am J Ophthalmol. 1989;107:323–30.

    Article  CAS  Google Scholar 

  52. Krachmer JH, Fenzl RE. Surgical correction of high postkeratoplasty astigmatism: relaxing incisions vs wedge resection. Arch Ophthalmol. 1980;98:1400–2.

    Article  CAS  Google Scholar 

  53. Sugar J, Kirk A. Relaxing keratotomy for post-keratoplasty high astigmatism. Ophthalmic Surg. 1983;14:156–8.

    CAS  PubMed  Google Scholar 

  54. Lavery GW, Lindstrom RL, Hofer LA, Doughman DJ. The surgical management of corneal astigmatism after penetrating keratoplasty. Ophthalmic Surg. 1985;16:165–9.

    CAS  PubMed  Google Scholar 

  55. Güell JL, Manero F, Müller A. Transverse keratotomy to correct high corneal astigmatism after cataract surgery. J Cataract Refract Surg. 1996;22:331–6.

    Article  Google Scholar 

  56. Lazzaro DR, Haight DH, Belmont SC, Gibralter RP, Aslanides IM, Odrich MG. Excimer laser keratectomy for astigmatism occurring after penetrating keratoplasty. Ophthalmology. 1996;103:458–64.

    Article  CAS  Google Scholar 

  57. Amm M, Duncker GIW, Schröder E. Excimer laser correction of high astigmatism after keratoplasty. J Cataract Refract Surg. 1996;22:313–7.

    Article  CAS  Google Scholar 

  58. Serdarevic ON, Renard GJ, Pouliquen Y. Videokeratoscopy of recipient peripheral corneas in combined penetrating keratoplasty, cataract extraction, and lens implantation. Am J Ophthalmol. 1996;122:29–37.

    Article  CAS  Google Scholar 

  59. *Strelow S, Cohen EJ, Leavitt KG, Laibson PR. Corneal topography for selective suture removal after penetrating keratoplasty. Am J Ophthalmol. 1991;112:657–65.

    Article  CAS  Google Scholar 

  60. Roper-Hall MJ. Control of astigmatism after surgery and trauma. Br J Ophthalmol. 1982;66:556–9.

    Article  CAS  Google Scholar 

  61. Kronish JW, Forster RK. Control of corneal astigmatism following cataract extraction by selective suture cutting. Arch Ophthalmol. 1987;105:1650–5.

    Article  CAS  Google Scholar 

  62. Potamitis T, Fouladi M, Eperjese F, McDonnell PJ. Astigmatism decay immediately following suture removal. Eye. 1997;11:84–6.

    Article  Google Scholar 

  63. *Navon SE. Topography after repair of full-thickness corneal laceration. J Cataract Refract Surg. 1997;23:495–501.

    Article  CAS  Google Scholar 

  64. Binder PS. Selective suture removal can reduce postkeratoplasty astigmatism. Ophthalmology. 1985;92:1412–6.

    Article  CAS  Google Scholar 

  65. Luntz MH, Livingstone DG. Astigmatism in cataract surgery. Br J Ophthalmol. 1977;61:360–5.

    Article  CAS  Google Scholar 

  66. Atkins AD, Roper-Hall MJ. Control of postoperative astigmatism. Br J Ophthalmol. 1985;69:348–51.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Imperial College Healthcare NHS Trust, London, UK

    Melanie Corbett

  2. University Hospital Coventry and Warwickshire, Coventry, UK

    Nicholas Maycock

  3. Manchester, UK

    Emanuel Rosen

  4. Department of Ophthalmology, St. Thomas Hospital, London, UK

    David O’Brart

Authors
  1. Melanie Corbett
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicholas Maycock
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emanuel Rosen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David O’Brart
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Corbett, M., Maycock, N., Rosen, E., O’Brart, D. (2019). Keratoplasty. In: Corneal Topography. Springer, Cham. https://doi.org/10.1007/978-3-030-10696-6_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-10696-6_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-10694-2

  • Online ISBN: 978-3-030-10696-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation