REVIEW  MODERN TECHNIQUES OF LAMELLAR KERATOPLASTY 

Minerva Oftalmologica 2018 December;60(4):219-25

DOI: 10.23736/S0026-4903.18.01819-6

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Lamellar keratoplasty to correct high-degree post penetrating keratoplasty astigmatism

Shay GUTFREUND ^{1, 2} ✉

¹ Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; ² Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

Post-operative high-degree astigmatism is the most common cause of poor visual outcomes after penetrating keratoplasty (PK). Relaxing incisions at the steep meridian are considered the preferred method to correct post-PK astigmatism. Nevertheless, incisions are frequently not made deep enough in order to avoid corneal perforation, consequently reducing the desired effect. Failure to achieve the required outcome can lead to a second PK procedure, which unnecessarily removes healthy endothelium, and exposes the patient to a renewed immunogenic stimulus. This review will present three techniques to manage high astigmatism degree occurring after PK. The first two procedures are microkeratome-assisted, allowing to preform safely full thickness penetrating corneal incisions combined with a variable modification of the anterior cornea. The third procedure enables to replace entire corneal stroma while sparing the healthy endothelium in those cases when microkeratome-assisted procedure is not safe.

KEY WORDS: Keratoplasty, penetrating - Astigmatism - Postoperative complications - Corneal transplantation