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Minerva Oftalmologica 2019 June;61(2):23-30

DOI: 10.23736/S0026-4903.19.01828-2


language: English

Thermokeratoplasty: an ally in corneal ectasias

Vincenzo MARCHESE 1 , Martina LO IACONO 2, Flavio CUCCO 3

1 Unit of Ophthalmology, Sant’Antonio Abate Hospital, Trapani, Italy; 2 Private practitioner, Trapani, Italy; 3 Ophthalmology Service, Candela Clinic, Palermo, Italy

Patients with corneal ectasia undergone to keratoplasty with standard techniques show, on average, a higher myopia and postoperative astigmatism than patients transplanted for other pathologies. This is due to the shape of the cornea which, in such cases, is steeper and due to the deeper anterior chamber. If the cut during keratoplasty varies along its circumference and it is asymmetrical and irregular, the recipient bed will not be round and the transplanted cornea will not take a spherical shape. The probability of obtaining a spherical cornea after keratoplasty is greater by changing the corneal conformation and approximating it to the normal one before trephination. We report two cases of advanced corneal ectasias below: a case of corneal hydrops secondary to advanced keratoconus with central corneal opacity and a case of pellucid marginal degeneration in the non-refractive phase. They were both treated with intraoperative cauterization of the corneal apex and subsequent penetrating keratoplasty. The thermal causticization of the corneal apex, carried out before trephination of the recipient bed, determines the contraction of the tissue and a flattening of the keratoectasia by reducing the corneal curvature and favoring the subsequent phases of full thickness corneal transplantation. In our opinion, the technique proves to be safe and effective in selected cases, facilitating surgical maneuvers and making them safer. Thus, the refractive results can be improved in postkeratoplasty by reducing postoperative myopia and astigmatism.

KEY WORDS: Keratoplasty, penetrating; Dilatation, pathologic; Cornea

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