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REVIEW  MODERN TECHNIQUES OF LAMELLAR KERATOPLASTY 

Minerva Oftalmologica 2018 December;60(4):172-82

DOI: 10.23736/S0026-4903.18.01810-X

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Microkeratome-assisted deep anterior lamellar keratoplasty

Paolo SANTORUM 1, 2, Massimo BUSIN 2, 3, 4

1 Department of Ophthalmology, “San Maurizio” Regional Hospital, Bolzano, Italy; 2 Department of Ophthalmology, Villa Igea Private Hospitals, Forlì, Italy; 3 International Institute of Research and Education in Ophthalmology (IRFO), Forlì, Italy; 4 Department of Morphology, Surgery and Experimental Surgery, University of Ferrara, Ferrara, Italy



Despite the undisputed advantages over penetrating keratoplasty in terms of endothelial survival, the popularity of deep anterior lamellar keratoplasty is still limited. The main limitation to its widespread adoption is the difficult and poorly reproducible surgical technique of corneal lamellar dissection. Microkeratome-assisted anterior lamellar keratoplasty is an alternative procedure that overcomes this limitation: the dissections of both the donor and the recipient cornea are performed by means of a microkeratome-based automated dissection system. This surgical technique is straightforward and highly reproducible, but the maximum corneal dissection depth remains always only pre-Descemetic. All articles about microkeratome-assisted anterior lamellar keratoplasty were reviewed. Surgical technique, indications, preoperative evaluation, and postoperative management are described in detail. Published results and complications are reported and compared to those of the alternative procedures: penetrating keratoplasty and deep anterior lamellar keratoplasty. Microkeratome-assisted anterior lamellar keratoplasty provides visual outcomes comparable to those of penetrating keratoplasty as well as of deep anterior lamellar keratoplasty. Complications are minimized by means of a pre-Descemetic and extraocular approach. The usage of an automated corneal dissection system flattens the learning curve and reduces surgical time. Microkeratome-assisted anterior lamellar keratoplasty is an effective technique for the surgical treatment of visual impairment due to corneal diseases that do not affect the posterior-most part of the cornea. Because its safety and reproducibility compare favorably with those of the alternative procedures, microkeratome-assisted anterior lamellar keratoplasty should be considered whenever the normal corneal function can be restored by means of a dissection that is only pre-Descemetic in depth.


KEY WORDS: Corneal transplantation - Keratomileusis, laser in situ - Eye, surgery

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