Innovative technique to allow lamellar grafting in a cornea with significant localised thinning

Session Details

Session Title: Cornea: Surgical I

Session Date/Time: Tuesday 08/09/2015 | 08:00-10:30

Paper Time: 10:18

Venue: Room 10

First Author: : H.Suleman UK

Co Author(s): :    J. Gandhewar   B. Ilango                 

Abstract Details

Purpose:

To describe a novel technique allowing the performance of automated anterior lamellar keratoplasty (AALK) in a cornea that was otherwise contraindicated for the procedure.

Setting:

Wolverhampton Eye Infirmary, Wolverhampton,UK

Methods:

A 54 year old female with right eye herpetic stromal scarring and best corrected visual acuity (BCVA) of 6/12 was evaluated for right corneal graft surgery. Topography revealed an irregular cornea with the thinnest point measuring 223 microns at the edge of the central 4mm zone. During surgery under local anaesthesia, localised stromal hydration in the thinnest area was applied using physiological saline in a 1ml syringe and a 27G needle. The host lamella of 250 micron was dissected (Gebauer microkeratome) and a 250 microns donor lamella applied with inlay sutures. Standard post-operative management was instituted.

Results:

The postoperative course was uneventful. At 1 week the inlay suture was removed and BCVA was 6/18. At 6 weeks postoperative, the BCVA was 6/12 and the graft was clear. Topography showed the thinnest point to be 259 microns and astigmatism was at the preoperative level (3.9D). Mild cataract in the right eye may have contributed to the impaired BCVA.

Conclusions:

This novel method allowed AALK in a patient that would have otherwise required full thickness grafting with all the inherent risks. Visual rehabilitation has been speeded up, corneal integrity maintained and there is no risk of endothelial rejection. This technique may be applicable in allowing surgery, such as LASIK, to be carried out in patients with significantly thinned corneas. We propose that this technique is considered in cases where localised thinning may preclude lamellar grafting or similar surgery and allow patients the benefits of this type of surgery over conventional full thickness grafting.

Financial Interest:

NONE