Visual outcomes of the second eye in keratoconic patients who have a corneal graft in the first eye: analysis at 12 years

Purpose: To analyze demographic, clinical, and keratometric outcomes of the second eye in keratoconic patients when the first eye has already been grafted, initially and finally at 12 years. Methods: Retrospective analysis of initial and 12 years visual and keratometric outcomes of the second eye in keratoconic patients when the first one has already been grafted. Results: A total of 107 patients were included: 66 patients were analyzed at the beginning of the follow-up and at 12 years. There were no statistically significant differences with regard to the correction method from the beginning to the end of the follow-up; 3% of patients underwent crosslinking and 4.5% an intracorneal ring segments implantation. There was no significant progress in corneal opacities (1.5% vs 3.0% at 12 years) or visual comfort (90.9% vs 87.9%). The mean values of best-corrected visual acuity (BCVA) (0.69 vs 0.71 at 12 years, on a decimal scale), cylinder (-2.64 D vs -3.13 D), spherical equivalent, and keratometry (46.34 D vs. 46.49 D) had not significantly changed during the follow-up period. During the follow-up, 41 patients (38.3%) received a penetrating or lamellar keratoplasty on the contralateral eye (63% in the 5 years after the first corneal graft). At the time of the keratoplasty procedure, corneal opacities were seen in 7 patients (17.1%), mean BCVA was 0.26 +/- 0.16, spherical equivalent mean was -3.70 D, mean cylinder was 3.89 D, mean keratometry values were 52.65 +/- 6.80 D, and mean pachymetry value was 335.50 mu m. Conclusions: This study suggests that the period of risk of keratoplasty in the second eye is significant in the first 5 years following the first keratoplasty. New therapeutic treatments have been made available, allowing for stabilization of the keratoconus decreasing the impact of transplantation.