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Surgical Technique | June 2012 Surgeon's Corner

Outcomes From a Modified Microkeratome-Assisted Lamellar Keratoplasty for Keratoconus

Massimo Busin, MD; Vincenzo Scorcia, MD; Luca Zambianchi, MD; Diego Ponzin, MD

Arch Ophthalmol. 2012;130(6):776-782. doi:10.1001/archophthalmol.2011.1546.

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ABSTRACT

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To improve visual and refractive outcomes, microkeratome-assisted lamellar keratoplasty for the treatment of keratoconus (exchange of a 9.0-mm anterior recipient lamella with a 9.0-mm donor lamella, using a 200-μm head for the former and a 300-μm head for the latter) was modified by adding a 6.5-mm incomplete full-thickness incision in the recipient bed before suturing the donor graft in place. After complete suture removal, 1 year postoperatively, best spectacle-corrected visual acuity was 20/40 or better in 92 of 97 eyes and 20/25 or better in 67 of 97 eyes; regular astigmatism was 4.5 diopters or worse in 86 of 97 eyes; endothelial cell loss averaged 20.4%. The disruption of the recipient's architecture induced by the full-thickness circular incision makes the final corneal shape closely resemble the physiologic curvature of the donor cornea, thus optimizing postoperative refractive error and spectacle-corrected visual acuity.

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Figure 1. Surgical technique. A, Marking the recipient cornea. B, Microkeratome-assisted dissection of the recipient cornea. C, Punching the donor lamella. D, Trephination in the residual recipient bed. E, Full-thickness incision completed. F, Anterior donor lamella sutured in place.

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Figure 2. Clinical appearance of a microkeratome-assisted lamellar keratoplasty 1 year postoperatively.

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Figure 3. Distribution of uncorrected visual acuity over time.

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Figure 4. Distribution of best spectacle-corrected visual acuity over time.

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Figure 5. Slitlamp appearance of microkeratome-assisted lamellar keratoplasty 1 day postoperatively. A, Corneal edema and double-chamber formation are evident. B, A few hours after filling the anterior chamber with air, the cornea is transparent with no double chamber.

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Figure 6. Postoperative slitlamp appearance of microkeratome-assisted lamellar keratoplasty 1 month postoperatively. A, Folds in the recipient cornea involve the pupil area. B, One year postoperatively, after all sutures have been removed, the folds have disappeared.

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Figure 7. Corneal topography of a cornea with central keratoconus. A, Before surgery. B, One month postoperatively. C, One year after microkeratome-assisted lamellar keratoplasty.

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Busin M, Scorcia V, Zambianchi L, Ponzin D. Outcomes From a Modified Microkeratome-Assisted Lamellar Keratoplasty for Keratoconus. Arch Ophthalmol. 2012;130(6):776-782. doi:10.1001/archophthalmol.2011.1546.

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