Lens opacities after nonmechanical versus mechanical corneal trephination for keratoplasty in keratoconus

Behrens, A.; Seitz, B.; Langenbucher, A.; Kus, M.M.; Küchle, M.; Naumann, G.O.

Journal of Cataract and Refractive Surgery 26(11): 1605-1611


ISSN/ISBN: 0886-3350
PMID: 11084267
DOI: 10.1016/s0886-3350(00)00717-3
Accession: 046537411

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To compare the lens opacity formation after penetrating keratoplasty (PKP) using nonmechanical excimer laser corneal trephination and mechanical motor trephination. SETTTING: University Eye Clinic, University of Erlangen-Nürnberg, Erlangen, Germany. Ninety-six patients with keratoconus (96 eyes) and clear crystalline lenses were randomly assigned to the nonmechanical trephination (NMT) group (n = 46; 35 men; mean age 38.2 years +/- 10.8 [SD]) or the mechanical trephination (MT) group (n = 50; 35 men; mean age 34.4 +/- 9.0 years). Suturing and postoperative treatment were identical. Dilated pupil biomicroscopy and slitlamp lens photography were performed preoperatively and postoperatively at 3 month intervals. Opacities were identified as cortical, nuclear, and posterior subcapsular and graded from 1 (mild) to 3 (severe). Mean follow-up in the NMT/MT group was 3.2 +/- 1.3 years/3.4 +/- 1.1 years. Overall, incident opacities appeared in 23.9%/32.0% of eyes (4.3%/6.0% cortical; 19. 6%/26.0% posterior subcapsular; 0%/0% nuclear) (P =.833). All cortical opacities in both groups were grade 1; posterior subcapsular opacities were grade 1 in 66.6%/61.5% of eyes and grade 2 in 22.2%/30.8% of eyes. One patient in each group presented grade 3 posterior subcapsular opacities. No differences between trephination methods were seen in a 5 year Kaplan-Meier cumulative risk of lens opacity formation (P =.763 cortical, P =.530 posterior subcapsular). In addition to its optical advantages, nonmechanical corneal trephination appears to have no adverse impact on cataract formation after PKP for keratoconus.