Comparing deep anterior lamellar keratoplasty and automated lamellar therapeutic keratoplasty in patients with keratoconus
ABSTRACT We compared outcomes of deep anterior lamellar keratoplasty (DALK) and automated lamellar therapeutic keratoplasty (ALTK) in patients with keratoconus.
Seventy eyes with keratoconus that underwent corneal transplantation using either DALK (n = 40) or ALTK (n = 30) were included in this retrospective study. DALK was performed with Anwar's big-bubble technique and ALTK using an ALTK system. Best-corrected visual acuity (BCVA), refractive results, and complications were analyzed.
Mean follow-up in the DALK (16.68 ± 3.36 months) and ALTK (15.27 ± 2.50 months) groups were similar (p = 0.058). Mean final BCVA of patients in the DALK group was 0.31 ± 0.14 logarithm of the minimum angle of resolution (logMAR) and in the ALTK group 0.34 ± 0.15 logMAR, (p = 0.492). Corresponding figures for final postoperative spherical equivalents were -3.45 ± 0.77 D and -4.19 ± 0.99 D, respectively (p = 0.001). Final postoperative degree of astigmatism was similar in the two groups: DALK -4.28 ± 0.66 D; ALTK -4.50 ± 1.05 D (p = 0.307).
Final visual acuity outcomes were comparable for the DALK and ALTK groups. Thus, ALTK seem to be as efficacious as DALK for surgical treatment of keratoconus.
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ABSTRACT: PURPOSE: To describe a new surgical technique allowing dissection down to Descemet membrane in big-bubble deep anterior lamellar keratoplasty (DALK) with failed big-bubble formation (the "microbubble incision technique"). METHODS: This is an interventional case series of 10 consecutive patients with keratoconus undergoing intended big-bubble DALK with failure to establish a normal big bubble. In all patients, repeated air injections into the stroma were performed, leaving a whitish colored stroma. Lamellar dissection as far down as possible was then performed within this white tissue. As soon as the anterior chamber was visible, a large remaining intrastromal air bubble was incised with a sharp 15-degree knife introduced perpendicular to the tissue to open up this predescemetic bubble. If deeper air bubbles were still visible, this approach was repeated. Using a blunt spatula, this new layer was then prepared and viscodissection performed. RESULTS: Using this novel approach, in 9 of the 10 patients, it was possible to dissect down to Descemet membrane. Macroperforation made conversion to penetrating keratoplasty necessary in 1 patient. Microperforations not necessitating conversion occurred in 2 patients. All 9 patients with "rescued" DALK had an uneventful postoperative course and had a mean visual acuity of 20/63 ± 20/125 (range, 20/500-20/50) and a mean endothelial cell count of 1672 ± 163 cells per square millimeter (range, 1493-1867 cells/mm) at 3 months. CONCLUSIONS: Microbubble incision is a new rescue technique for big-bubble DALK patients without bubble formation allowing for a safer dissection down to Descemet membrane.Cornea 03/2012; 32(2). DOI:10.1097/ICO.0b013e31824a226f · 2.36 Impact Factor
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ABSTRACT: We evaluated fitting feasibility and visual results of miniscleral lenses in highly irregular post corneal graft patients.•Two different types of corneal graft – lamellar and full thickness – were compared together.•Barriers to acceptance of miniscleral lenses were evaluated.•Patients’ tolerance and potential complications were evaluated in follow up visits.Contact Lens & Anterior Eye 10/2014; 38(1). DOI:10.1016/j.clae.2014.10.001 · 2.00 Impact Factor
Article: Targeted corneal transplantation.[Show abstract] [Hide abstract]
ABSTRACT: Corneal transplantation surgery has moved from an era of conventional penetrating keratoplasty to selective replacement of the diseased corneal layer with complementary healthy donor corneal tissue. Anterior lamellar transplantation surgeries do not involve replacement of corneal endothelium, consequently eliminating the occurrence of endothelial rejection. Similarly, in diseases affecting the corneal endothelium, selective replacement with a lamellar lenticule bearing healthy endothelium provides better outcomes in terms of ocular surface, lesser astigmatism and quick visual recovery. In addition to the advantages of enhanced surgical outcomes, targeted corneal transplantation allows the use of one donor cornea for more than one recipient, thereby offering a viable solution to the problem of paucity of donor corneas. Evolving techniques of corneal transplantation have enabled better utilization of donor corneal tissue. Anterior lamellar as well as endothelial keratoplasty surgeries have become first-choice surgeries in appropriately selected cases. This review briefly discusses some of these novel surgical techniques. A better understanding of targeted corneal transplantation would lead to adaptation of the concept of component corneal surgery. This would further enable the corneal surgeons to circumvent the problem of donor corneal shortage especially in the developing world.Current opinion in ophthalmology 05/2012; 23(4):324-9. DOI:10.1097/ICU.0b013e32835484a1 · 2.64 Impact Factor