Posters

TULK: tuck-in lamellar keratoplasty

Poster Details

First Author: J.Kasireddy INDIA

Co Author(s):                        

Abstract Details

Purpose:

In the recent past DALK emerged as a technique of choice for advanced keratoconus. DALK failed to address two issues mainly , the recipient cornea beyond the graft is still weak and elastic and continues to stretch and become ectatic in significant number cases in long term. Secondly, DALK requires sutures for a long period of time 6 months are more for healing and stronger bond at edges.Tulk in lamellar keratoplasty is modified DALK in which 10 mm lamellar graft is transplanted peripherally with in the recipient stroma and centrally replacing the recipient stroma.

Setting:

Sankara Academy of Vision, Sankara eye Hospital, Coimbatore, Tamil Nadu, India .

Methods:

The donor cornea mounted on artificial anterior chamber is partially trephined to 250 microns depth at 7.5 mm diameter and lamellar dissection is carried outward to the limbus. The donor cornea DM is removed  and punched with 10 mm trephine. In the recipient 250 microns depth groove is made at 7.25 mm diameter and outward lamellar dissection was carried out at 250 microns depth till the limbus. The central portion of stroma is removed as with standard big bubble DALK technique. The donor perheral  lamellar collar is tucked with in the lamellar pocket of recipient and sutured .

Results:

The area of contact between graft and recipient at the edge in DALK of 8 mm size is 13 square mm. In TULK the total are of contact between the lamellar layers at periphery is 86 square mm .TULK  imparts a large area of contact for rapid healing facilitating early suture removal from 3 months on wards. Additionally the recipient cornea at the periphery till the limbus is reinforced with stromal layer of donor lamellar collar providing additional support. The addition of lamellar donor cornea in the periphery increases thickness of recipient cornea and prevents ectasia.

Conclusions:

TULK is a modified DALK and provides extra strength to the peripheral recipient cornea in keratoconus . The area of attachment is 7 times more there by facilitating early and strong healing between the donor and recipient. Early suture removal in addition gives early visual rehabilitation and and shortens the post operative follow ups. TULK is eloborative technique takes more intraoperative surgical time and reduces the number post operative visits and long term follow ups of regular DALK surgery.TULK provides additional strength to the peripheral recipient corneal till limbus and prevents late ectasia in Keratonus.

Financial Disclosure:

None