Aphakic keratoplasty: visual acuity and optical errors

Sixty-four consecutive patients with aphakic penetrating keratoplasty and penetrating keratoplasty combined with intracapsular cataract extraction were reviewed in a prospective fashion with a minimum of a one-year follow-up. Five were lost to follow-up. There were seven graft failures at the end of one year. Five of these were from 11 patients who underwent second operations because of failed grafts. Visual acuity was 20/80 or better in 29 of the patients. Pathology accounted for decreased visual acuity in all of those with visual acuity less then 20/80. Problems wre macular degeneration in 11 of the 23 patients with poor visual acuity (48%); marked cystoid macular edema in four patients (17%), advanced glaucoma in three patients (13%) and amblyopia in three patients (13%). Graft size had no significant effect on visual acuity. In terms of the final refractive error and astigmatism, there were no significant differences seen in those in whom a larger donor was used compared with those in whom a donor the same size as the recipient opening was used. Aphakic penetrating keratoplasty has shown outstanding technical success with poor visual acuity representing a difficulty in screening for non-corneal pathology. With an otherwise normal eye, the chances for excellent optical success are very good at the present time with modern techniques in aphakic penetrating keratoplasty.