To the Editor.
—We read with interest the case report of posterior keratoconus described by Streeten et al' in the April Archives. A 16-year-old girl underwent penetrating keratoplasty in an eye that was noted to have central corneal opacities since birth; when operated on she had a visual acuity of 20/70.A visual acuity of 20/70 may be functional; grafting with the hope of improving vision seems aggressive. Complications after corneal transplantation are common and include graft failure, rejection, glaucoma, and cataract. Indeed, a visual acuity of 20/70 after corneal transplantation may be acceptable. Furthermore, even if one could expect a substantially improved acuity after grafting a 20/70 eye, one would still have to be skeptical with this patient because of the reasonable possibility of an amblyopia having arisen from the patient's congenital central corneal opacity. Certainly, laser interferometry or an equivalent test should have been done to verify the
Perlstein SH, Chubak GS. Posterior Keratoconus. Arch Ophthalmol. 1984;102(2):195. doi:10.1001/archopht.1984.01040030149014