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B. E. Frueh, C. K. Brinkmann, S. Wolf, U. Wolf-Schnurrbusch; Macular Edema Secondary to Penetrating Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4675.
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Recovery of visual acuity may sometimes lag behind corneal recovery after penetrating keratoplasty (PKP). The possibility of secondary macular edema (ME) has previously been reported. In this study we used OCT for detection of ME after PKP and give an estimate of incidence and predisposing conditions.
Included were patients undergoing PKP in our clinic during a period from February 2006 till November 2006, giving consent to an additional examination using optical coherence tomography (StratusOCT, Zeiss Meditech, Dublin, CA) in mydriasis. We furthermore noted PKP indication, gender, age, best corrected visual acuity (BCVA, LogMAR), intraocular pressure (IOP), and ocular comorbidity
28 patients (13 f /15 m) underwent successful OCT examinations 1 month after PKP, whereof 17 (6 f /11 m) were examined another 3 months later. Mean age was 66±17 years, 6 patients were active smokers (mean 10 pack years). Indications for PKP were bullous keratopathy (8), Fuch’s endothelial dystrophy (9), keratoconus (5), corneal scar (3), herpetic keratitis (2), and lattice dystrophy (1). 4 of 26 had undergone simultaneous phacoemulsification and IOL implantation. Mean BCVA after one month was -.964 (LogMAR), and improved significantly to -.524 (LogMAR) after 4 months (paired t-test: p < .002). Mean central foveal thickness after one month: 225 ± 100, after four months: 233 ± 139 microns (no significant difference between both measurements, paired t-test: p = .45). Patients undergoing simultaneous cataract surgery did not seem to differ from other patients concerning retinal thickness (unpaired t-test: p > 16.1). IOP remained stable in all patients between the two visits, measuring 15.9 ± 0.5 and 15.9 ± 0.4 mmHg respectively (paired t-test: p = .95). We were able to detect ME in 3 patients: one had a history of macular hole, the other suffered from non-proliferative diabetic retinopathy. Only one had no other concomitant ocular findings. In the 3 eyes with ME, indication for surgery was bullous keratopathy.
ME secondary to PKP is a condition that does not seem to occur with significantly increased frequency. Following the hint that bullous keratopathy may lead to secondary ME, further longitudinal studies using OCT technology ought to be performed. OCT is a valid method to detect ME following PKP.
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