EJO ISSN 1120-6721 European Journal of Ophthalmology 2018, Vol. 28(1) 19–24 © The Author(s) 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.5301/ejo.5000996 journals.sagepub.com/home/ejo ORIGINAL RESEARCH ARTICLE The incidence of this disease is about 1/2,000 (1) but its frequency, partcularly in its subclinical form, has substantal- ly increased in recent years. It is incidentally detected dur- ing preoperatve assessments for refractve surgery and its diagnosis relies on the analysis of precise corneo-topographic data. There are many therapeutc optons available for the treatment of this disease. The frst-line management of astg- matsm is based on optcal correcton through glasses or contact lenses (rigid gas-permeable [RGP] lenses (4), scleral lenses (5)), while second-line management is based on place- ment of intrastromal corneal rings (ICR) (6). Furthermore, cross-linking (7) is useful in the management of progressive keratoconus. When all these therapies are insufcient, or for inital corneal opacites with a low VA, corneal transplanta- ton (8) is imperatve (deep anterior lamellar keratoplasty or penetratng keratoplasty). The incidence of keratoplasty for keratoconus is report- ed to be on average 10% to 64% in the literature (9). In 2012 in France, 804 corneas were grafed for keratoconus, Visual outcomes of the second eye in keratoconic patents who have a corneal graf in the frst eye: analysis at 12 years Anne-Sophie Gauthier 1 , Marie Friot 1 , Marc Puyraveau 2 , Thibaud Garcin 3 , Maher Saleh 1 , Phillipe Gain 3 , Bernard Delbosc 1 1 Department of Ophthalmology, University Hospital, Besançon - France 2 Faculty of Medicine, University of Franche-Comté, Besançon - France 3 Department of Ophthalmology, University Hospital, Saint-Etenne - France Introducton Keratoconus is an ectatc corneal dystrophy usually appear- ing during adolescence. The conditon has a slowly progressive course, leading to corneal protrusion, irregular astgmatsm, corneal opacites, and a drop in visual acuity (VA) (1, 2). The exact pathogenesis remains nonelucidated. Histologic lesions are predominant at the level of Bowman membrane and the corneal stroma (3). ABSTRACT Purpose: To analyze demographic, clinical, and keratometric outcomes of the second eye in keratoconic patents when the frst eye has already been grafed, initally and fnally at 12 years. Methods: Retrospectve analysis of inital and 12 years visual and keratometric outcomes of the second eye in keratoconic patents when the frst one has already been grafed. Results: A total of 107 patents were included: 66 patents were analyzed at the beginning of the follow-up and at 12 years. There were no statstcally signifcant diferences with regard to the correcton method from the begin- ning to the end of the follow-up; 3% of patents underwent crosslinking and 4.5% an intracorneal ring segments implantaton. There was no signifcant progress in corneal opacites (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 signif- cantly changed during the follow-up period. During the follow-up, 41 patents (38.3%) received a penetratng or lamellar keratoplasty on the contralateral eye (63% in the 5 years afer the frst corneal graf). At the tme of the keratoplasty procedure, corneal opacites were seen in 7 patents (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 µm. Conclusions: This study suggests that the period of risk of keratoplasty in the second eye is signifcant in the frst 5 years following the frst keratoplasty. New therapeutc treatments have been made available, allowing for sta- bilizaton of the keratoconus decreasing the impact of transplantaton. Keywords: Evoluton, Keratoconus, Nongraf eye Accepted: May 12, 2017 Published online: June 10, 2017 Corresponding author: Anne-Sophie Gauthier, MD Department of Ophthalmology University Hospital Besançon 3 Boulevard Alexandre Fleming 25030 Besançon, France asophiegauthier@yahoo.fr