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Similar BCVA seen in congenital aniridia patients who underwent limbal autograft or PK

Acta Ophthalmol. 2008;86(7):735-740.

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No statistically significant difference was found in long-term postoperative best corrected visual acuity between eyes that underwent limbal transplantation or penetrating keratoplasty in patients with congenital aniridia.

In addition, a statistically significant difference was not found in long-term BCVA between operated and non-operated eyes.

The retrospective, interventional case series compared 88 eyes in 45 patients with congenital aniridia who underwent treatment between 1956 and the present. Corneal and ocular surface findings were identified, and patients were classified into two groups: those who had undergone operation and those who received another form of treatment. As primary surgery, limbal allograft was performed in 10 eyes and PK was performed in 13 eyes.

"Improvements in BCVA are difficult to measure because of other concomitant pathologies such as cataract, glaucoma and foveal hypoplasia," the researchers said. "Most of the patients are satisfied with the results when the grafts are functioning despite no statistically significant improvement in their BCVA."

Glaucoma was found in 66% of eyes in the no-surgery group and in 62% of eyes in the surgery group.

This study is further confirmation of the poor long-term visual prognosis in patients who undergo corneal and ocular surface surgery for congenital aniridia. The researchers found that visual prognosis is no different with or without keratoplasty. Although the short-term visual prognosis was better with limbal transplant, there was no significant difference in the long term. These findings encourage a more conservative approach. Aniridia is a profibrotic disorder and, as a result, surgical intervention is more likely to fail. This study highlights the need for a different surgical approach such as the use of the Boston keratoprosthesis. This then requires long-term follow-up studies to evaluate visual prognosis, prosthesis failure and risk of infection.

– Michael O’Keefe, MD
Mater Private Hospital, Dublin, Ireland