Comparison of biomechanical properties between post penetrating keratoplasty and deep anterior lamellar keratoplasty in keratoconus patients using ocular response analyser
Keywords:
Ocular response analyser, Keratoconus, Deep anterior lamellar keratoplasty, Penetrating Keratoplasty
Abstract
Introduction: Corneal biomechanics have been studied over recent years. The Ocular Response Analyser (ORA) is the first simple device able to measure the biomechanical properties of the cornea. Deep anterior lamellar keratoplasty (DALK) is considered an alternative procedure to penetrating keratoplasty (PK) in advanced keratoconus patients that leaves the host corneal endothelium and Descemet’s membrane intact. This provides thea dvantage of an absence of potential corneal endothelial rejection. The aim of the study was to compare the biomechanics between the two keratoplasty techniques.
Method: This prospective comparative study included 150 eyes of150 patients. Patients were divided into 3 groups. 50 eyes with no previous surgery (Group1), 50 eyes of post PK (Group2) and 50 eyes of post DALK (Group 3) in advanced keratoconus patients were included in the study. Corneal Hysteresis (CH), corneal resistance factor (CRF), Goldmann- correlated intraocular pressure (IOPg) and corneal compensated intraocular pressure (IOPcc) was measured using Reichert ocular response analyser at 1 year follow up.
Results: Mean age of the patients in PK group was 24.2±6.83 years and 20.95±6.49 yrs in DALK group ( p value < 0.126 , statistically insignificant). Mean CH in control group (10.9±1.42) and DALK group (10.5±3.79) was significantly higher than PK group(9.1±2.36)( p value < 0.01). Mean CRF in control group (10.6±2.56) and DALK group (10.1±3.2) was significantly higher than PK group (8.87±2.68) ( p value <0.01). However in these groups no statistically significant difference was seen in IOPcc and IOPg.
Conclusions: Corneal biomechanical properties in post penetrating keratoplasty and lamellar procedures differ significantly.
Downloads
Download data is not yet available.
References
1. Rabinowitz YS. Keratoconus (Review).Surv Ophthalmol.1998Jan-Feb;42(4): 297-319.
2. Chihara E, Takahashi H, Okazaki K, Park M, TanitoM.The pre-operative intraocular pressure level predictsthe amount of underestimated intraocular pressureafter LASIK for myopia. Br J Ophthalmol 2005Feb;89(2):160-4.doi.10.1136/bjo.2004.048074.
3. Ortiz D, Piñero D, Shabayek MH, Arnalich-MontielF,Alió JL. Corneal biomechanical properties in normal,post-laser in situ keratomileusis, and keratoconiceyes.J Cataract Refract Surg 2007 Aug; 33(8): 1371–5. doi.10.1016/j.jcrs.2007.04.021. [PubMed]
4. Davison PF, Glabavy EJ. Connective tissue remodellingin corneal and scleral wounds. Invest Ophthalmol VisSci 1986Oct;27(10):1478-84. [PubMed]
5. Gassett AR, Dohlman CH. The tensile strength ofcorneal wounds.Arch Ophthalmol 1968May;79(5):595-602. [PubMed]
6. Simonsen AH, Andreassen TT, BendixK.The healingstrength of corneal wounds in the human eye.Exp EyeRes 1982Sep;35(3):287-92. [PubMed]
7. Smelser GK, Polack FM, Ozanics V. Persistence ofdonor collagen in corneal transplants. Exp Eye Res 1965Dec;4(4):349-54. [PubMed]
8. Reinhart WJ, Musch DC, Jacobs DS, Lee WB, Kaufman SC,Schtein RM. Deep anterior lamellar keratoplasty as an alternativeto penetrating keratoplasty a report by American Academy ofOphthalmology. Ophthalmology. 2011Jan;118(1):209-18. doi: 10.1016/j.ophtha.2010.11.002.
9. Luce DA. Determining in vivo biomechanical properties of thecornea with an ocular response analyzer. J Cataract Refract Surg.2005Jan;31(1):156-62.doi:10.1016/j.jcrs.2004.10.044. [PubMed]
10. Feizi S, Einollahi B, Yazdani S, Hashemloo A. Graft biomechanicalproperties after penetrating keratoplasty in keratoconus.Cornea. 2012;Aug;31(8):855-8. doi: 10.1097/ICO.0b013e31823f8ce4. [PubMed]
11. Shah S, Laiquzzaman M, Bhojwani R, Mantry S, CunliffeI.Assessment of the biomechanical properties of the cornea withthe ocular response analyzer in normal and keratoconic eyes.Invest Ophthalmol Vis Sci. 2007Jul;48(7):3026-31.doi:10.1167/iovs.04-0694.
12. Vajpayee R, Maharana P, Sharma N.Journal of Cataract and refractive Surgeries.2014Feb;40(2):276-82. doi: 10.1016/j.jcrs.2013.07.047. [PubMed]
13. Troutman RC, Lawless MA. Penetrating keratoplasty for keratoconus.Cornea. 1987;6(4):298-305. [PubMed]
14. Lim L, Pseudovs K, Coster DJ. Penetrating keratoplasty for keratoconus: visual outcome and success. Ophthalmology.2000Jun;107(6):1125-31.doi:10.1016/S0161-6420(00)00112-3. [PubMed]
15. Melles GR, Lander F, Rietvelt FJ, Remeijer L, BeekhuisWH,Binder PS. A new surgical technique for deep stromal, anteriorlamellarkeratoplasty.Br J Ophthalmol. 1999Mar;83(3):327-33. [PubMed]
16. Reinhart WJ, Musch DC, Jacobs DS, Lee WB, Kaufman SC,Schtein RM. Deep anterior lamellar keratoplasty as an alternativeto penetrating keratoplasty a report by American Academy ofOphthalmology. Ophthalmology. 2011Jan;118(1):209-18. doi: 10.1016/j.ophtha.2010.11.002.
17. Javadi MA, Feizi S, Yazdani S, Mirbabaee F. Deep anteriorlamellar keratoplasty versus penetrating keratoplasty for keratoconus.A clinical trial. Cornea. 2010Apr;29(4):365-71. doi: 10.1097/ICO.0b013e3181b81b71. [PubMed]
18. Al-Torbak AA, Al-Motowa S, Al-Assiri A, Al-KharashiS,Al-Shahwan S, Al-Mezaine H, et al. Deep anterior lamellarkeratoplasty for keratoconus. Cornea. 2006May;25(4):408-12.doi: 10.1097/01.ico.0000220777.70981.46. [PubMed]
19. Shin JY, Choi SJ, Oh JY, Kim MK, Lee JH, Wee WR. Evaluationof corneal biomechanical properties following penetrating keratoplastyusing the ocular response analyzer.Korean J Ophthalmol.2010Jun;24(3):139-42. doi: 10.3341/kjo.2010.24.3.139.
20. Edmund C. Assessment of an elastic model in the pathogenesis ofkeratoconus.ActaOphthalmol. 1987Oct;65(5):545-50. [PubMed]
21. Foster CS, Yamamato GK. Ocular rigidity in keratoconus. Am JOphthalmol. 1978Dec;86(6):802-6. [PubMed]
22. Edmund C. Corneal rigidity and ocular rigidity in normal andkeratoconic eyes.ActaOphthalmol. 1988;Apr;66(2):134-40. [PubMed]
23. Hartstein J, Becker B. Research into the pathogenesis of keratoconus:a new syndrome low ocular rigidity, contact lenses andkeratoconus. Arch Ophthalmol. 1970Dec;84(6):728-9. [PubMed]
24. Yenerel NM, Kucumen RB, Gorgun E. Changes in corneal biomechanicsin patients with keratoconus after penetrating keratoplasty.Cornea. 2010 Nov;29(11):1247-51. doi: 10.1097/ICO.0b013e3181ca6383. [PubMed]
25. Ortiz D, Pinero D, Shabayek MH, Arnalich-Montiel F, Alio´ JL.Corneal biomechanical properties in normal, post laser in situkeratomileusis, and keratoconic eyes. J Cataract Refract Surg.2007Aug;33(8):1371-5.doi.10.1016/j.jcrs.2007.04.021. [PubMed]
26. Qazi MA, Sanderson JP, Mahmoud AM, Yoon EY, Robetrs CJ,Pepose JS. Postoperative changes in intraocular pressure andcorneal biomechanical metrics-Laser in situ keratomileusis versuslaser assisted subepithelial keratectomy. J Cataract Refract Surg.2009Oct;35(10):1774-88. doi: 10.1016/j.jcrs.2009.05.041.
27. Kamiya K, Shimizu K, Ohmoto F. The changes in corneal biomechanicalparameters after phototherapeutic keratectomy ineyes with granular corneal dystrophy. Eye. 2009Sep;23(9):1790-5. doi: 10.1038/eye.2008.373. [PubMed]
28. Randleman JB, Russell B, Ward MA, Thompson KP, StultingRD. Risk factors and prognosis for corneal ectasia after LASIK.Ophthalmology. 2003Feb;110(2):267-75.doi:10.1016/S0161-6420(02)01727-X. [PubMed]
29. Wittig-Silva C, Whiting M, Lamoureux E, Lindsay RG, SullivanLJ, Snibson GR. A randomized controlled trial of corneal collagencross-linking in progressive keratoconus: preliminary results.J Refract Surg. 2008Sep;24(7):S720-5.
30. Raiskup-Wolf F, Hoyer A, Spoerl E, Pillunat LE. Collagen crosslinkingwith riboflavin and ultraviolet—a light in keratoconus:long-term results. J Cataract Refract Surg. 2008May;34(5):796-801. doi: 10.1016/j.jcrs.2007.12.039. [PubMed]
31. Vinciguerra P, Albe E, Mahmoud MM, Trazza S, HafeziF,Roberts CJ. Intra- and postoperative variation in ocular responseanalyzer parameters in keratoconic eyes after corneal crosslinking.J Refract Surg. 2010Sep;26(9):669-76. doi: 10.3928/1081597X-20100331-01. [PubMed]
32. Gkika M, Labiris G, Glarmoukakais A, KoutsogianniaA,KozobolisV.Evaluation of corneal hysteresis and corneal resistance factor after corneal cross linking for keratoconus.Graefes ArchClinExp Ophthalmol.2012Apr;250(4):565-73. doi: 10.1007/s00417-011-1897-0.
33. Jafarinasab MR, Sepehr F, Javadi MA, Hashemloo A. Graftbiomechanical properties after penetrating keratoplasty versusdeep anterior lamellar keratoplasty. Curr Eye Res. 2011May;36(5):417-21. doi: 10.3109/02713683.2011.556303. [PubMed]
34. Hosny M, Hassaballa MAM, Shalaby A. Changes in cornealbiomechanics following different keratoplasty techniques. ClinOphthalmol2011;5:767-70. doi: 10.2147/OPTH.S21297 [PubMed]
35. AcarB T, Akdemir M Acar S Corneal biomechanical properties in eyes with no previous surgery, with previous penetrating keratoplasty and with deepanterior lamellar keratoplasty. Jpn J Ophthalmol 2013 Jan;57(1):85-9. doi: 10.1007/s10384-012-0197-5. 10.1111/aos.12136.
36. AcarB T, Akdemir M Acar S Corneal biomechanical properties in eyes with no previous surgery, with previous penetrating keratoplasty and with deepanterior lamellar keratoplasty. Jpn J Ophthalmol 2013 Jan;57(1):85-9. doi: 10.1007/s10384-012-0197-5.
2. Chihara E, Takahashi H, Okazaki K, Park M, TanitoM.The pre-operative intraocular pressure level predictsthe amount of underestimated intraocular pressureafter LASIK for myopia. Br J Ophthalmol 2005Feb;89(2):160-4.doi.10.1136/bjo.2004.048074.
3. Ortiz D, Piñero D, Shabayek MH, Arnalich-MontielF,Alió JL. Corneal biomechanical properties in normal,post-laser in situ keratomileusis, and keratoconiceyes.J Cataract Refract Surg 2007 Aug; 33(8): 1371–5. doi.10.1016/j.jcrs.2007.04.021. [PubMed]
4. Davison PF, Glabavy EJ. Connective tissue remodellingin corneal and scleral wounds. Invest Ophthalmol VisSci 1986Oct;27(10):1478-84. [PubMed]
5. Gassett AR, Dohlman CH. The tensile strength ofcorneal wounds.Arch Ophthalmol 1968May;79(5):595-602. [PubMed]
6. Simonsen AH, Andreassen TT, BendixK.The healingstrength of corneal wounds in the human eye.Exp EyeRes 1982Sep;35(3):287-92. [PubMed]
7. Smelser GK, Polack FM, Ozanics V. Persistence ofdonor collagen in corneal transplants. Exp Eye Res 1965Dec;4(4):349-54. [PubMed]
8. Reinhart WJ, Musch DC, Jacobs DS, Lee WB, Kaufman SC,Schtein RM. Deep anterior lamellar keratoplasty as an alternativeto penetrating keratoplasty a report by American Academy ofOphthalmology. Ophthalmology. 2011Jan;118(1):209-18. doi: 10.1016/j.ophtha.2010.11.002.
9. Luce DA. Determining in vivo biomechanical properties of thecornea with an ocular response analyzer. J Cataract Refract Surg.2005Jan;31(1):156-62.doi:10.1016/j.jcrs.2004.10.044. [PubMed]
10. Feizi S, Einollahi B, Yazdani S, Hashemloo A. Graft biomechanicalproperties after penetrating keratoplasty in keratoconus.Cornea. 2012;Aug;31(8):855-8. doi: 10.1097/ICO.0b013e31823f8ce4. [PubMed]
11. Shah S, Laiquzzaman M, Bhojwani R, Mantry S, CunliffeI.Assessment of the biomechanical properties of the cornea withthe ocular response analyzer in normal and keratoconic eyes.Invest Ophthalmol Vis Sci. 2007Jul;48(7):3026-31.doi:10.1167/iovs.04-0694.
12. Vajpayee R, Maharana P, Sharma N.Journal of Cataract and refractive Surgeries.2014Feb;40(2):276-82. doi: 10.1016/j.jcrs.2013.07.047. [PubMed]
13. Troutman RC, Lawless MA. Penetrating keratoplasty for keratoconus.Cornea. 1987;6(4):298-305. [PubMed]
14. Lim L, Pseudovs K, Coster DJ. Penetrating keratoplasty for keratoconus: visual outcome and success. Ophthalmology.2000Jun;107(6):1125-31.doi:10.1016/S0161-6420(00)00112-3. [PubMed]
15. Melles GR, Lander F, Rietvelt FJ, Remeijer L, BeekhuisWH,Binder PS. A new surgical technique for deep stromal, anteriorlamellarkeratoplasty.Br J Ophthalmol. 1999Mar;83(3):327-33. [PubMed]
16. Reinhart WJ, Musch DC, Jacobs DS, Lee WB, Kaufman SC,Schtein RM. Deep anterior lamellar keratoplasty as an alternativeto penetrating keratoplasty a report by American Academy ofOphthalmology. Ophthalmology. 2011Jan;118(1):209-18. doi: 10.1016/j.ophtha.2010.11.002.
17. Javadi MA, Feizi S, Yazdani S, Mirbabaee F. Deep anteriorlamellar keratoplasty versus penetrating keratoplasty for keratoconus.A clinical trial. Cornea. 2010Apr;29(4):365-71. doi: 10.1097/ICO.0b013e3181b81b71. [PubMed]
18. Al-Torbak AA, Al-Motowa S, Al-Assiri A, Al-KharashiS,Al-Shahwan S, Al-Mezaine H, et al. Deep anterior lamellarkeratoplasty for keratoconus. Cornea. 2006May;25(4):408-12.doi: 10.1097/01.ico.0000220777.70981.46. [PubMed]
19. Shin JY, Choi SJ, Oh JY, Kim MK, Lee JH, Wee WR. Evaluationof corneal biomechanical properties following penetrating keratoplastyusing the ocular response analyzer.Korean J Ophthalmol.2010Jun;24(3):139-42. doi: 10.3341/kjo.2010.24.3.139.
20. Edmund C. Assessment of an elastic model in the pathogenesis ofkeratoconus.ActaOphthalmol. 1987Oct;65(5):545-50. [PubMed]
21. Foster CS, Yamamato GK. Ocular rigidity in keratoconus. Am JOphthalmol. 1978Dec;86(6):802-6. [PubMed]
22. Edmund C. Corneal rigidity and ocular rigidity in normal andkeratoconic eyes.ActaOphthalmol. 1988;Apr;66(2):134-40. [PubMed]
23. Hartstein J, Becker B. Research into the pathogenesis of keratoconus:a new syndrome low ocular rigidity, contact lenses andkeratoconus. Arch Ophthalmol. 1970Dec;84(6):728-9. [PubMed]
24. Yenerel NM, Kucumen RB, Gorgun E. Changes in corneal biomechanicsin patients with keratoconus after penetrating keratoplasty.Cornea. 2010 Nov;29(11):1247-51. doi: 10.1097/ICO.0b013e3181ca6383. [PubMed]
25. Ortiz D, Pinero D, Shabayek MH, Arnalich-Montiel F, Alio´ JL.Corneal biomechanical properties in normal, post laser in situkeratomileusis, and keratoconic eyes. J Cataract Refract Surg.2007Aug;33(8):1371-5.doi.10.1016/j.jcrs.2007.04.021. [PubMed]
26. Qazi MA, Sanderson JP, Mahmoud AM, Yoon EY, Robetrs CJ,Pepose JS. Postoperative changes in intraocular pressure andcorneal biomechanical metrics-Laser in situ keratomileusis versuslaser assisted subepithelial keratectomy. J Cataract Refract Surg.2009Oct;35(10):1774-88. doi: 10.1016/j.jcrs.2009.05.041.
27. Kamiya K, Shimizu K, Ohmoto F. The changes in corneal biomechanicalparameters after phototherapeutic keratectomy ineyes with granular corneal dystrophy. Eye. 2009Sep;23(9):1790-5. doi: 10.1038/eye.2008.373. [PubMed]
28. Randleman JB, Russell B, Ward MA, Thompson KP, StultingRD. Risk factors and prognosis for corneal ectasia after LASIK.Ophthalmology. 2003Feb;110(2):267-75.doi:10.1016/S0161-6420(02)01727-X. [PubMed]
29. Wittig-Silva C, Whiting M, Lamoureux E, Lindsay RG, SullivanLJ, Snibson GR. A randomized controlled trial of corneal collagencross-linking in progressive keratoconus: preliminary results.J Refract Surg. 2008Sep;24(7):S720-5.
30. Raiskup-Wolf F, Hoyer A, Spoerl E, Pillunat LE. Collagen crosslinkingwith riboflavin and ultraviolet—a light in keratoconus:long-term results. J Cataract Refract Surg. 2008May;34(5):796-801. doi: 10.1016/j.jcrs.2007.12.039. [PubMed]
31. Vinciguerra P, Albe E, Mahmoud MM, Trazza S, HafeziF,Roberts CJ. Intra- and postoperative variation in ocular responseanalyzer parameters in keratoconic eyes after corneal crosslinking.J Refract Surg. 2010Sep;26(9):669-76. doi: 10.3928/1081597X-20100331-01. [PubMed]
32. Gkika M, Labiris G, Glarmoukakais A, KoutsogianniaA,KozobolisV.Evaluation of corneal hysteresis and corneal resistance factor after corneal cross linking for keratoconus.Graefes ArchClinExp Ophthalmol.2012Apr;250(4):565-73. doi: 10.1007/s00417-011-1897-0.
33. Jafarinasab MR, Sepehr F, Javadi MA, Hashemloo A. Graftbiomechanical properties after penetrating keratoplasty versusdeep anterior lamellar keratoplasty. Curr Eye Res. 2011May;36(5):417-21. doi: 10.3109/02713683.2011.556303. [PubMed]
34. Hosny M, Hassaballa MAM, Shalaby A. Changes in cornealbiomechanics following different keratoplasty techniques. ClinOphthalmol2011;5:767-70. doi: 10.2147/OPTH.S21297 [PubMed]
35. AcarB T, Akdemir M Acar S Corneal biomechanical properties in eyes with no previous surgery, with previous penetrating keratoplasty and with deepanterior lamellar keratoplasty. Jpn J Ophthalmol 2013 Jan;57(1):85-9. doi: 10.1007/s10384-012-0197-5. 10.1111/aos.12136.
36. AcarB T, Akdemir M Acar S Corneal biomechanical properties in eyes with no previous surgery, with previous penetrating keratoplasty and with deepanterior lamellar keratoplasty. Jpn J Ophthalmol 2013 Jan;57(1):85-9. doi: 10.1007/s10384-012-0197-5.
CITATION
DOI: 10.17511/ijmrr.2015.i9.175
Published: 2015-10-31
How to Cite
1.
Nawaz S, Ahmad Sofi I, K. Maharana P, Shaveta S. Comparison of biomechanical properties between post penetrating keratoplasty and deep anterior lamellar keratoplasty in keratoconus patients using ocular response analyser. Int J Med Res Rev [Internet]. 2015Oct.31 [cited 2024Nov.22];3(9):939-46. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/348
Section
Original Article
OAI - Open Archives Initiative
