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Microkeratome-assisted sutureless anterior lamellar keratoplasty

Session Details

Session Title: Cornea Surgical II

Session Date/Time: Wednesday 09/10/2013 | 08:00-10:30

Paper Time: 10:00

Venue: Forum (Ground Floor)

First Author: : P.Santorum ITALY

Co Author(s): :    R. Barbara   E. Albè   C. Bovone   C. Russo   M. Busin  

Abstract Details

"Purpose:

To describe the surgical technique and report the outcomes of a case series of 24 patients presenting anterior stromal corneal opacities treated with microkeratome-assisted sutureless anterior lamellar keratoplasty (SALK).

Setting:

Prospective, interventional case series performed by the same surgeon (M.B.) at "Villa Igea" private Hospital - Forlì - Italy, from 2010 to 2012.

Methods:

Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA) and refraction were assessed preoperatively as well as 3, 6, 12, and 24 months postoperatively in 24 patients that had undergone microkeratome-assisted SALK to treat superficial anterior corneal opacities. A standardized SALK was performed in all cases and included: a. microkeratome-assisted (130 μm head n = 13; 200 μm head n = 10; head 300 μm = 1) removal of a superficial lamella from the recipient cornea; b. microkeratome-assisted (90 μm head n = 18; 130 μm head n = 6) preparation of an anterior lamella from a donor cornea punched to a diameter of 9 mm; c. placement of the donor tissue into the recipient bed and application of a bandage contact lens. In each case, the head used for the recipient cornea was selected in order to totally remove the opacity, while maintaining a residual recipient thickness of at least 250 μm. The donor lamella was cut with the 130 μm head only in the initial 6 cases.

Results:

Indications for SALK included: post-infectious stromal scars (n = 14); corneal dystrophies (n = 5); post-PRK haze (n = 4); and corneal degeneration (n = 1). SALK was combined with phacoemulsification and intraocular lens implantation in 2 eyes. Average preoperative BSCVA was 0.31 ± 0.25. Average BSCVA improved to 0.5 ± 0.15 at 3 months, 0.68 ± 0.1 at 6 months, 0.72 ± 0.12 at 12 months, and 0.78 ± 0.25 at 24 months postoperatively. The average refractive spherical equivalent decreased significantly from 6.42 ± 4.65D preoperatively to 4.12 ± 0.25D at 6 months after SALK and remained substantially unchanged thereafter. Mean refractive astigmatism increased from 1.56 ± 2.60 D preoperatively to 2.82 ± 1.64D at 6 months after SALK with no substantial change at the following postoperative examinations. No intraoperative complications were recorded. Postoperative complications included: residual scar in the recipient bed (n =2) and early flap dislocation (n = 1). No immunologic rejection, infection or epithelial ingrowth was observed in any case of this series during the 2-year follow-up.

Conclusions:

Sutureless anterior lamellar keratoplasty is a viable and effective procedure in treating corneal scars confined to the anterior stromal layers. The reduced thickness of the free cap donor lamella allows fast and safe sutureless attachment to the stromal bed reducing the operating time and costs. Visual and refractive outcomes are comparable to those of penetrating keratoplasty with the additional advantage of retaining the recipient endothelium. As opposed to “big bubble” anterior lamellar keratoplasty, the procedure is simple and standardized. Finally, at least theoretically, a single donor cornea could be used for two surgical procedures in different patients using the anterior lamella for a SALK and the posterior lamella for a DSAEK or a DMEK.

Financial Interest:

... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, ... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented"