Penetrating Keratoplasty for Keratoconus With or Without Vernal Keratoconjunctivitis

Purpose: The purpose of this study was to evaluate graft survival, postoperative complications, and visual outcome after penetrating keratoplasty (PKP) for keratoconus (KC) in eyes with or without a history of vernal keratoconjunctivitis (VKC). Methods: A retrospective review was conducted on all cases of PKP performed at King Khaled Eye Specialist Hospital between January 1, 1997, and December 31, 2001, for KC. Results: Four hundred sixty-four eyes were included in the study, including 80 (17.2%) eyes with VKC and 384 (82.8%) without VKC. Five-year graft survival was 97.3% and 95.5% in eyes with or without VKC, respectively. There were no statistically significant differences in Kaplan-Meier graft survival between the 2 groups at any time interval. There were no statistically significant differences in the percentage of eyes experiencing postoperative complications in eyes with or without VKC (27.5% vs 31.8%, respectively; P = 0.50). However, late-onset persistent epithelial defects were significantly more likely to occur in eyes with VKC (6.3% vs 1.8%; P = 0.04). There were no significant differences in the prevalence of endothelial rejection, bacterial keratitis, glaucoma, wound dehiscence, early-onset persistent epithelial defects, or secondary cataract. The median final best-corrected visual acuity was 20/30 in both groups. The percentage of eyes with a final best-corrected visual acuity of 20/40 or better was 76.2% in eyes with VKC and 71.9% in eyes without VKC (P = 0.49). Conclusions: Graft survival, postoperative complications, and visual outcome are comparable after PKP for KC in eyes with or without VKC.

[1]  P. E. Dantas,et al.  [Trends in the indications for penetrating keratoplasty]. , 2008, Arquivos brasileiros de oftalmologia.

[2]  M. Wagoner,et al.  Escalation of glaucoma therapy after penetrating keratoplasty. , 2007, Ophthalmology.

[3]  F. Mantelli,et al.  Clinical grading of vernal keratoconjunctivitis , 2007, Current opinion in allergy and clinical immunology.

[4]  M. Zimmerman,et al.  Corneal transplant survival after onset of severe endothelial rejection. , 2007, Ophthalmology.

[5]  Santa Jeremy Ono,et al.  Effect of allergic conjunctival inflammation on the allogeneic response to donor cornea. , 2007, Investigative ophthalmology & visual science.

[6]  M. Wagoner,et al.  Inverse relationship between age and severity and sequelae of acute corneal hydrops associated with keratoconus , 2007, British Journal of Ophthalmology.

[7]  M. Zimmerman,et al.  Bacterial keratitis after penetrating keratoplasty: incidence, microbiological profile, graft survival, and visual outcome. , 2007, Ophthalmology.

[8]  M. Kanavi,et al.  Indications for Penetrating Keratoplasty in Iran , 2007, Cornea.

[9]  Kathy Y Cao,et al.  Indications for penetrating keratoplasty in a tertiary referral centre in Canada, 1996-2004. , 2007, Canadian journal of ophthalmology. Journal canadien d'ophtalmologie.

[10]  Y. Akova,et al.  Secondary Bacterial Keratitis Associated With Shield Ulcer Caused by Vernal Conjunctivitis , 2006, Cornea.

[11]  D. Musch,et al.  Extended long-term outcomes of penetrating keratoplasty for keratoconus. , 2006, Ophthalmology.

[12]  D. Ponzin,et al.  The CORTES Study: Corneal Transplant Indications and Graft Survival in an Italian Cohort of Patients , 2006, Cornea.

[13]  M. Plebani,et al.  Th1- and Th2-type cytokines in chronic ocular allergy , 2006, Graefe's Archive for Clinical and Experimental Ophthalmology.

[14]  K. Fukuda,et al.  Role of structural cells of the cornea and conjunctiva in the pathogenesis of vernal keratoconjunctivitis , 2006, Progress in Retinal and Eye Research.

[15]  H. Souri,et al.  Outcomes of Penetrating Keratoplasty in Keratoconus , 2005, Cornea.

[16]  K. Tsubota,et al.  Atopic Ocular Surface Disease: Implications on Tear Function and Ocular Surface Mucins , 2005, Cornea.

[17]  Terry Kim,et al.  Trends in the Indications for Penetrating Keratoplasty, 1980-2001 , 2005, Cornea.

[18]  A. Solomon,et al.  Forty Years of Changing Indications in Penetrating Keratoplasty in Israel , 2005, Cornea.

[19]  A. Murakami,et al.  Mast Cell Chymase Decreases the Barrier Function and Inhibits the Migration of Corneal Epithelial Cells , 2005, Current eye research.

[20]  S. Eğrilmez,et al.  The effect of vernal keratoconjunctivitis on clinical outcomes of penetrating keratoplasty for keratoconus. , 2004, Canadian journal of ophthalmology. Journal canadien d'ophtalmologie.

[21]  M. Wagoner,et al.  Changing Indications for Corneal Transplantation at the King Khaled Eye Specialist Hospital (1983–2002) , 2004, Cornea.

[22]  S. Daya,et al.  Penetrating keratoplasty: indications over a 10 year period , 2004, British Journal of Ophthalmology.

[23]  M. Claesson,et al.  Corneal grafts at St John Eye Hospital, Jerusalem, January 2001–November 2002 , 2004, British Journal of Ophthalmology.

[24]  A. Lambiase,et al.  Allergic chronic inflammation of the ocular surface in vernal keratoconjunctivitis , 2003, Current opinion in allergy and clinical immunology.

[25]  J. Streilein.  Ocular immune privilege: the eye takes a dim but practical view of immunity and inflammation , 2003, Journal of leukocyte biology.

[26]  Robert W. Thompson,et al.  Long-term graft survival after penetrating keratoplasty. , 2003, Ophthalmology.

[27]  K. Tsubota,et al.  Tear function and ocular surface changes in keratoconus. , 2003, Ophthalmology.

[28]  P. Garg,et al.  Recurrent shield ulcer following penetrating keratoplasty for keratoconus associated with vernal keratoconjunctivitis. , 2003, Indian journal of ophthalmology.

[29]  G. Rao,et al.  Fungal Keratitis Associated With Vernal Keratoconjunctivitis , 2003, Cornea.

[30]  M. Taneja,et al.  Penicillium keratitis in vernal Keratoconjunctivitis. , 2002, Indian journal of ophthalmology.

[31]  A. Leonardi.  Vernal keratoconjunctivitis: pathogenesis and treatment , 2002, Progress in Retinal and Eye Research.

[32]  E. Cohen,et al.  Indications for Penetrating Keratoplasty and Associated Procedures, 1996–2000 , 2002, Cornea.

[33]  C. McGhee,et al.  Indications for Corneal Transplantation in New Zealand: 1991–1999 , 2002, Cornea.

[34]  K. Dobbins,et al.  Trends in the Indications for Penetrating Keratoplasty in the Midwestern United States , 2000, Cornea.

[35]  N. Sarvananthan,et al.  Does ethnic origin influence the incidence or severity of keratoconus? , 2000, Eye.

[36]  M. Wagoner,et al.  Penetrating Keratoplasty in Eyes with Keratoconus and Vernal Keratoconjunctivitis , 2000, Cornea.

[37]  R. Olson,et al.  Penetrating keratoplasty for keratoconus: a long-term review of results and complications. , 2000, Journal of cataract and refractive surgery.

[38]  K. Pesudovs,et al.  Penetrating keratoplasty for keratoconus: visual outcome and success. , 2000, Ophthalmology.

[39]  T. Oshika,et al.  A 10-year review of penetrating keratoplasty. , 2000, Japanese journal of ophthalmology.

[40]  K. Tabbara,et al.  Ocular complications of vernal keratoconjunctivitis. , 1999, Canadian journal of ophthalmology. Journal canadien d'ophtalmologie.

[41]  P. Asbell,et al.  Changing Indications for Penetrating Keratoplasty: Histopathology of 1,250 Corneal Buttons , 1998, Cornea.

[42]  G. Del Prete,et al.  Th1/Th2 balance in human disease. , 1998, Transplantation proceedings.

[43]  K. Buzard,et al.  Corneal transplant for keratoconus: Results in early and late disease , 1997, Journal of cataract and refractive surgery.

[44]  U. Stenevi,et al.  The results of penetrating keratoplasty for keratoconus. , 2009, Acta ophthalmologica Scandinavica.

[45]  A. Lambiase,et al.  Estrogen and progesterone receptors in vernal keratoconjunctivitis. , 1995, Ophthalmology.

[46]  J. A. Cameron,et al.  Shield ulcers and plaques of the cornea in vernal keratoconjunctivitis. , 1995, Ophthalmology.

[47]  R. D. Stulting,et al.  Risk factors for corneal graft failure and rejection in the collaborative corneal transplantation studies. Collaborative Corneal Transplantation Studies Research Group. , 1994, Ophthalmology.

[48]  J. Zieske,et al.  Eosinophil granule major basic protein inhibition of corneal epithelial wound healing. , 1994, Investigative ophthalmology & visual science.

[49]  G. Gleich,et al.  Eosinophil granule major basic protein deposition in corneal ulcers associated with vernal keratoconjunctivitis. , 1993, American journal of ophthalmology.

[50]  G. Stern,et al.  Bacterial keratitis associated with vernal keratoconjunctivitis. , 1992, Cornea.

[51]  F. Price.  Penetrating keratoplasty for keratoconus , 1992, The British journal of ophthalmology.

[52]  T A Casey,et al.  Penetrating keratoplasty for keratoconus: complications and long-term success. , 1991, The British journal of ophthalmology.

[53]  J. A. Cameron,et al.  Corneal ectasia in vernal keratoconjunctivitis. , 1989, Ophthalmology.

[54]  P. Donshik,et al.  Tear lactoferrin levels in patients with external inflammatory ocular disease. , 1987, Investigative ophthalmology & visual science.

[55]  P. Paglen,et al.  The prognosis for keratoplasty in keratoconus. , 1982, Ophthalmology.