Ways to Improve (Visual) Outcome in Corneal Transplantation, Corneal Pathology

The normally transparent cornea can lose its ability to refract light regularly from various conditions. Among these conditions are corneal opacities and corneal diseases leading to a distortion of the corneal contour. Vision might be restored by a corneal transplantation. Corneal transplantation is widely practised and can be very successful. The high success rate of corneal transplantation has been attributed to the avascularity of the cornea and the immune privileged site of the cornea. The leading cause, however, of corneal graft failure is graft rejection. The incidence of graft rejection and failure is increased in high-risk patients having corneal vascularisation or a history of previous graft rejection. For a patient to benefit from corneal transplantation the graft must be optically clear with minimal aberrations. Consequently, reducing corneal graft failure and reducing postoperative astigmatism can improve the outcome of a corneal transplantation. The aim of studies described in this thesis was to improve the (visual) outcome of corneal transplantations. The ultimate life span of each corneal graft is limited, even if an immune reaction has never occurred. In an attempt to postpone a corneal graft we investigated the toric Artisan lens as an alternative to correct high astigmatism associated with keratoconus and marginal degeneration. The toric Artisan lens was also investigated in eyes without corneal pathology.