Clinical and Functional Results of Combined Surgical Treatment of a Patient with Keratoconus: 10-year Follow-up Experience

Relevance. Despite the development of modern technologies of lamellar keratoplasty, keratoconus (KK) remains one of the most common indications for penetrating keratoplasty (PKP). However, transparent engraftment of donor tissue is not enough to achieve high visual acuity. Postoperative astigmatism remains an urgent problem. In this regard, in 2015 we proposed a method for intraoperative prevention of postkeratoplastic astigmatism.
Objective: to present the long-term clinical and functional results of treating a patient with KK after PKP with one-stage implantation of an open ring into the graft.
Patient and methods. First time the patient came to the clinic in 2012 with a history of high myopia (HM) and complaints of decreased visual acuity (VA) in both eyes. The patient underwent a comprehensive primary diagnosis, based on the results of which the following diagnosis was made: HM, KK stage 3–4 in both eyes. In 2012, PKP was performed on OD, in 2015, PKP with femtosecond accompaniment and one-stage implantation of an open ring into the graft on OS. In 2023, phacoemulsification of cataracts (PEC) was performed on both eyes with implantation of: OD — a toric intraocular lens (tIOL); OS — a monofocal aspheric IOL. Results. After 12 years (OD) and 10 years (OS) of follow-up after multi-stage surgical treatment, the graft is transparent, the IOL is in the correct position; on OS, the intrastromal ring is in the correct position, adapted in the stroma. VA was OD = 0.9 n/c; OS = 1.0, while the amount of astigmatism according to keratopography on OS was -0.9D, on OD -3.2D.
Conclusion. This clinical case demonstrates remote clinical and functional results, where over a follow-up period of more than 10 years, there is no intrastromal ring dislocation and no graft reaction, stable IOL position, and minimal astigmatism. Carrying out SKP with one-stage implantation of an open ring into the graft is a safe and effective method of treating patients with CC.

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