Purpose: To compare the surgically induced astigmatism after penetrating keratoplasty (PK) in cases performed by supervised corneal fellows and experienced corneal surgeons. Methods: Data from a retrospective chart review of 32 cases of PK performed by 2 corneal surgeons with a combined experience of 30 years was compared to 33 cases of PK performed by 2 corneal fellows. Astigmatism was calculated using scalar and vector methods from preoperative keratometry and postoperative simulated keratometry from corneal topography at one year. Suture removal was performed as needed based on topography and refraction. Results: Mean surgically induced scalar astigmatism for the fellow group was 3.16 ±4.65 D and for the attending surgeon group was 4.33 ±4.35 D. Surgically induced vector cylinder was 4.23 ±3.63 D for the fellows and 3.87 ±2.97 D for the attending surgeons. Surgically induced vector astigmatism in the first six months of corneal fellowship was 6.45 ±4.22 D compared to 3.59 ±3.09 D in the last six months of training. Analysis of X and Y axis components of the surgically induced vector cylinder showed much greater astigmatism in the Y axis in both groups which likely corresponds to 6 and 12 o'clock cardinal suture placement. Conclusions: Supervised PK surgery performed by fellows in training results in much higher rates of astigmatism in the first 6 months when compared to experienced surgeons. In the later stages of training, the surgically induced cylinder by vector methods was equivalent in the two surgeon groups. This study supports the concept that corneal fellowship training improves the astigmatic outcome of penetrating keratoplasty and is efficacious when closely supervised by experienced transplant surgeons.
|Original language||English (US)|
|Journal||Investigative Ophthalmology and Visual Science|
|State||Published - Feb 15 1996|
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