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Ana L. Hofling-Lima, Gustavo Macedo, Eduardo Martinez, Rossen M. Hazarbassanov; Topography Based Photorefractive Keratectomy With Mitomycin C For Correction Of Irregular Astigmatism In Patients After Full-thickness Corneal Transplantation. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5745.
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To evaluate visual acuity changes on patients with corneal transplants (PKP), who undergone photorefractive keratectomy (PRK) based on topography (Topolink) with mitomycin C (MMC).
This is a case series study of 19 ammetropic patients (-8.75 to 3.25D) with penetrating corneal transplant due to keratoconus (16), corneal dystrophy (2) and leukoma (1) with astigmatism (-7.75 to -2.0 D) who undergone PRK with MMC. Corneal topography of all patients was measured using a Pentacam (Oculus, Germany), a Shack-Hartmann type wavefront analyzer (Schwind Ocular Wavefront Analyzer) and Placido-based topography (Corneal Wavefront Analyzer, Schwind eye-tech-solutions GmbH, Germany), pre-operatively and 12 months post-operatively.
Twelve months after topography assisted PRK with MMC, best spectacle corrected visual acuity (BSCVA) of 20/20 or better was achieved on 42.11% of the eyes, compared to 5.26 % of the eyes before surgery (p=0.0221, Χ2 test). At this period, two patients lost lines of BSCVA, 20/20 to 20/50 and 20/20 to 20/30, while one line or more of BSCVA were gained in all of the others (p=0.0005; paired simple t test). There was significant reduction of astigmatism pre operative (-5.37 ± 1.45D) compared to pos operative (-2.99 ± 1.98D) (paired simple, t test p=0.003), as well corneal best fit sphere and mean keratometry (paired single t test; p=0.0001). Central corneal thickness was also significantly reduced (paired simple, t test p=0.0003), with increase of anterior chamber volume (p< 0.0001). There was significant decrease on corneal RMS total (9.51 ± 2.74 microns to7.23 ± 2.78 microns; p=0.0002; paired simple t test) and corneal high spherical aberration HSA (1.04 ± 0.89 to 0.78 ± 0.94 microns; p=0.0014; paired simple t test).
At 12 months post surgery BSCVA improved significantly, there was gain of lines and reduction of astigmatism, corneal best fit sphere and mean keratometry, corneal thickness, corneal RMS total and corneal HSA. Based on our 6 month follow up, astigmatism and corneal thickness reduction were maintained. Photorefractive keratectomy (PRK) with topography based (Topolink) with MMC might be a better alternative for correction of irregular astigmatism post PKP.
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