The role of penetrating keratoplasty and epikeratoplasty in the surgical management of keratoconus.

A series of 86 penetrating keratoplasties for keratoconus was analysed. The surgery, using an 8.2 mm donor cornea into an 8.0 mm recipient opening, was performed between January 1983 and January 1986. The donor cornea was secured by two opposing continuous sutures, placed at full corneal thickness under surgical keratometry control. Both sutures were removed on average 30 weeks after surgery. The mean postoperative sutures out astigmatism was 5.4 dioptres (range 0 to 19.0), and following astigmatism surgery in 17 eyes, the mean astigmatism was 4.3 dioptres (range 0 to 10.5). Graft reaction occurred in 11.6% but was cleared medically in all cases and no corneas were lost. One month after suture removal, with spectacle correction, 45.5% of the primary group achieved vision of 6/6, 90.7% were 6/9 or better, and 97.7% were 6/12 or better. Comparing these results with recently published data on epikeratoplasty, for the treatment of keratoconus, it is evident that penetrating keratoplasty offers the best means whereby the eye can obtain its full visual potential.