ORIGINAL ARTICLE  MODERN TECHNIQUES OF LAMELLAR KERATOPLASTY 

Minerva Oftalmologica 2018 December;60(4):156-61

DOI: 10.23736/S0026-4903.18.01811-1

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Superficial anterior lamellar keratoplasty: description of technique and presentation of results

Jacqueline BELTZ ^{1, 2, 3} ✉, Silvana MADI ^{2, 3, 4}, Paolo SANTORUM ^{2, 3, 5}

¹ Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia; ² Department of Ophthalmology, Villa Igea Private Hospitals, Forlì, Forlì-Cesena, Italy; ³ Istituto Internazionale per Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Forlì-Cesena, Italy; ⁴ Department of Ophthalmology, Alexandria University, Alexandria, Egypt; ⁵ Department of Ophthalmology, San Maurizio Regional Hospital, Bolzano, Italy

BACKGROUND: To describe the surgical technique, report the outcomes, and review the literature of superficial anterior lamellar keratoplasty (SALK) performed for corneal opacities of the anterior third of corneal stroma.
METHODS: We reviewed the records of all patients with opacities in the anterior third of the cornea, who underwent SALK at our Institution from March 2003 to November 2011. The procedure included always: 1) microkeratome-assisted superficial keratectomy and preparation of an anterior lamella from donor tissue placed on an artificial anterior chamber; 2) positioning and fixation onto the recipient bed of the lamellar graft punched to correct size with or without overlay sutures. Best spectacle-corrected visual acuity (BSCVA), manifest refraction and corneal topography were evaluated preoperatively and 1, 3, 6, 12 months postoperatively, as well as every year thereafter.
RESULTS: Forty-two eyes of 35 patients were identified. Causes for corneal opacity included dystrophies (N.=24), post-PRK haze (N.=7), traumatic scars (N.=6), subepithelial scars after sterile stromal melting in persistent epithelial defect (N.=5). Average follow-up was 24 months (range from 1 to 84 months). BSCVA improved in 40 eyes (95%), and was ≥20/40 in 36 (86%) eyes and ≥20/20 in 9 (21%) eyes. Refractive astigmatism was within 4 diopters in 86% of eyes. Complications included dystrophy recurrence (N.=4), stromal melting (N.=2), graft dislocation (N.=1), epithelial ingrowth (N.=1), infectious keratitis (N.=1) and stromal rejection (N.=1).
CONCLUSIONS: SALK is a simple and effective procedure with visual and refractive outcomes comparable to those of penetrating keratoplasty (PK). Unlike PK, it is extraocular and does not involve endothelial transplantation, thus eliminating the risks of both “open-sky” surgery and irreversible graft rejection.

KEY WORDS: Keratoplasty, Penetrating - Corneal opacity - Patient outcome assessment