Comparing deep anterior lamellar keratoplasty and automated lamellar therapeutic keratoplasty in patients with keratoconus

Haydarpasa Numune Education and Research Hospital, Ophthalmology Clinic, Istanbul, Turkey.
Japanese Journal of Ophthalmology (Impact Factor: 1.68). 06/2011; 55(4):327-32. DOI: 10.1007/s10384-011-0044-0
Source: PubMed


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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    • "Unfortunately, however, the unaided visual result of keratoplasty in a significant percentage of these patients is still far from satisfactory. Up to 4 diopter (and even more) astigmatism, both regular and irregular, is very common [1] [12] [13]. Although femtosecond laser assisted surgery seems promising [14] [15], many post graft patients need some means other than spectacles to improve their vision [16] [17]. "
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    ABSTRACT: Objective: To evaluate fitting feasibility, efficacy, and safety of mini scleral contact lenses in correcting post corneal graft vision. Methods: Prospective interventional case series, 56 visually unsatisfied post corneal graft eyes of 45 patients were fitted with miniscleral lenses (15.8 mm). Keratometric values, UCVA and BSCVA, fit, best corrected vision with the lens, decision to order lens, comfortable daily wearing time (CDWT), contact lens handling issues, and contact lens related complications were documented. Results: The mean age was 34.6 years (SD: 10.9), ranging from 8 to 63 years. Forty-three eyes had history of full thickness corneal graft, 12 eyes had deep anterior lamellar graft (DALK) and 1 eye had the rotational graft. The mean UCVA was 1.05 logMar (SD: 0.54), ranging from 0.30 to 2.52 logMar. The mean BSCVA was 0.73 logMar (SD: 0.50) ranging from 0.09 to 2.00 which improved to 0.17 logMar (SD: 0.19) with the miniscleral lens. All eyes had ideal (40 eyes) or acceptable (16 eyes) fits. Nineteen patients (23 eyes) ordered their lenses of whom 11 (14 eyes) continued using the lens with a mean follow up time of 21.92 months (SD: 6.8). These patients reported a mean CDWT of 9.62 h/day (SD: 4.5). Five eyes of 4 patients discontinued the lens. Four eyes were lost to follow-up. The main reported barriers for ordering the lenses were economic and handling concerns. Conclusion: Miniscleral contact lenses can be considered helpful in the visual management of post corneal graft patients. Other factors may influence the acceptance of the lenses.
    No preview · Article · Oct 2014 · Contact Lens & Anterior Eye
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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.
    No preview · Article · Mar 2012 · Cornea
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    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.
    No preview · Article · May 2012 · Current opinion in ophthalmology
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