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R. Steinbach, J. Duong, A. Joussen, K. Huber; The Influence of Krumeich Guided Trephine System and Manual Trephination on the Outcome of Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2335. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To compare visual acuity and astigmatism after keratoplasty between two trephination alternatives: Krumeich guided trephine system (GTS) and manual trephination.
A retrospective study was made with 24 patients suffering Fuchs’ endothelium dystrophy who underwent primary corneal transplantation. 12 patients were operated with manual trephination and for 12 patients the Krumeich GTS was used. Patients who received any ophthalmic surgery during study time were excluded. Visual acuity and astigmatism were measured before and twice after transplantation: 10 months after transplantation, still remaining the double running cross-stitch suture, and 18 months after keratoplasty when stitches have been removed.
After 10 months: The refractive astigmatism was 3.46 +/- 2.2D in the manual trephination group and 3.4 +/- 1.7D in the Krumeich GTS group. At the same time the median improvement of visual acuity in the manual trephination group reached 0.1 logMAR whereas 0.3 logMAR in the Krumeich GTS group. After 18 months: The refractive cylinder results were 4.43 +/- 2.5D for the manual trephination group and 4.46 +/- 2.23D for the Krumeich GTS group. The median visual acuity in the manual trephination group increased to 0.3 logMAR and remained 0.3 logMAR in the Krumeich GTS group. There is statistical evidence that astigmatism increases after removal of the stitches in both groups (p<0.01).
Our data show that there is no significant difference in improvement of visual acuity and refractive astigmatism between both surgical alternatives: the Krumeich GTS and manual trephination. Moreover, our data suggest that removal of double running cross-stitch suture increases refractive astigmatism.
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