نتايج پيوند قرنيه در مبتلايان به ديستروفي ماكولر قرنيه در مركز پزشكي لبافي نژاد

Results of Penetrating Keratoplasty in Macular Corneal Dystrophy

Purpose: To evaluate the outcomes of penetrating keratoplasty (PK) in macular corneal dystrophy (MCD) at Labbafinejad Medical Center, Tehran-Iran (1986-2002). Methods: In a descriptive study, records of patients with MCD who had undergone PK were reviewed. All cases were recalled for a complete ocular examination. Patients who participated in the recall examination with at least 6 months follow up were enrolled in the study. Results: Sixty-two eyes of 39 patients were included. The age of patients at first examination (before keratoplasty) was 30+12 (12-58) and at the time of keratoplasty was 34+10.3 (13-58) years. Duration of follow up after PK was 52+47.3(6-190) months. Best corrected vision before surgery in LogMAR notation was 1.4+0.4 (4/100). After PK, uncorrected visual acuity improved to 0.6+0.44 LogMAR (20/28) (P<0.0001) and best spectacle corrected visual acuity (BSCVA) at the end of follow up was 0.2+0.32 LogMAR (20/32). Spherical equivalent refractive error after surgery was -2.28+3.24 diopters and refractive astigmatism was 3.32+2.05 diopters. Suturing technique had no effect on final astigmatism after PK (P=0.9). BSCVA in 36 eyes who were operated before 35 years of age was 0.16+0.37 LogMAR and in 26 eyes operated at or after age 35 was 0.26+0.25 (P=0.005). Immunologic graft rejection occurred in 12 eyes (19.4%) during the follow up period. The first rejection occurred at 6.1+3.5 (2-14) months after PK. Graft opacification and failure occurred only in one eye following ocular trauma and wound dehiscence. The rest of the grafts (98.4%) were clear at the end of follow up. Conclusion: PK in patients with MCD improves vision significantly with excellent graft survival rates. In this study, patients who underwent PK before 35 years of age had better final visual acuity.