Penetrating keratoplasty is at present the accepted mode of treatment for patients with corneal endothelial damage resulting in corneal oedema. Corneal transplantation surgery has evolved since 1905, when eduard zirm, md, completed the first successful penetrating keratoplasty pkp procedure on a 45yearold farm laborer in what is now the czech republic. Where the corneal endothelium remains healthy, such as in keratoconus, corneal stromal dystrophies, and stromal scarring, the case for penetrating keratoplasty becomes unclear, and the debate as when to perform lamellar keratoplasty or penetrating. Manual lamellar dissection is technically very difficult, timeconsuming, and imprecise. Deep anterior lamellar keratoplasty dalk, which involves the removal of anterior diseased cornea while leaving deeper tissue intact, offers the. Deep anterior lamellar keratoplasty using precut anterior.
Keratoplasties definition of keratoplasties by medical. References for an introduction to corneal transplantation. Lamellar keratoplasty lkp is an alternative surgical procedure that requires removal of only the damaged or diseased epithelium and stroma, leaving the endothelium intact, in cases where only the more superficial layers are damaged. The second operation is usually a simple lamellar keratoplasty. Posterior lamellar keratoplasty for a case of pseudophakic bullous keratopathy. This process involves the use of a cookie cutter like. Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue the graft. Lamellar keratoplasty lk targets partial or lamellar replacement of diseased corneal tissue. Outcomes from a modified microkeratomeassisted lamellar. Occasionally, it is employed in the rehabilitation of thinned corneas or those with anterior opacification. Penetrating keratoplasty involved full thickness of the cornea.
Pdf lamellar keratoplasty lk has revolutionized corneal graft surgery in several ways. Presumed stromal graft rejection after automated lamellar. Prospective study of deep anterior lamellar keratoplasty. To improve visual and refractive outcomes, microkeratomeassisted lamellar keratoplasty for the treatment of keratoconus exchange of a 9. Purpose to evaluate the feasibility, safety and efficacy of deep anterior lamellar keratoplasty dalk using precut anterior lamellar cap alc for patients with herpes simplex keratitis. Deep anterior lamellar keratoplasty dalk full text. Depending on the depth of the lamellar dissection, either a full.
Lamellar keratoplasty involves transplantation of a part. Full text get a printable copy pdf file of the complete article 4. A surgical technique for posterior lamellar keratoplasty. Deep lamellar keratoplastyan alternative to penetrating.
This involves a partial thickness of the cornea that is transplanted to selectively replace only the diseased portion leaving the rest of the healthy cornea of the patient undisturbed. It is performed when there are persistent opacities leukomas of the cornea that cause a severe decrease in vision, in order to partially or completely. This article is from case reports in ophthalmology, volume 3. Femtosecond laserassisted anterior lamellar keratoplasty. Anterior lamellar keratoplasty american academy of. Endothelial cell loss and visual outcome of deep anterior. Deep anterior lamellar keratoplasty enables lamellar transplantation for deeper scars, loss of stromal tissue depressed scars or melts, or corneal ectasia ie, keratoconus and pellucid marginal degeneration. Penetrating keratoplasty cornea research foundation of. To report the management of a case of corneal melting two weeks after pterygium. Azar posterior lamellar endothelial keratoplasty refers to the removal of the diseased posterior corneal layers and their replacement by partialthickness donor tissue. Deep anterior lamellar keratoplasty dalk dalk is a partialthickness cornea transplant procedure that involves selective transplantation of the corneal stroma, leaving the native descemet membrane and endothelium in place.
The first, penetrating keratoplasty pk, is the traditional full thickness transplant where all three main layers of the corneathe epithelium, stroma and endotheliumare removed and replaced with donor tissue. Since the first successful penetrating keratoplasty pk was performed in 1905, corneal transplantation has become one of the most commonly performed tissue transplant procedures. These include anterior lamellar keratoplasty alk techniques that aim to selectively replace diseased corneal stroma and endothelial keratoplasty techniques aiming. Listing a study does not mean it has been evaluated by the u. The concept of lamellar keratoplasty lk is not new. However, the use of lamellar keratoplasty has been limited by difficulties such as irregularity and scarring of tissue interfaces, leading to poor visual outcomes. Keratoplastycorneal grafting corneal transplantation definition. Deep lamellar endothelial keratoplasty article about. Corneal melting two weeks after pterygium excision with. When scarring or corneal disease involves the front anterior part of the cornea, there are two surgical options to consider. It is an operation in which the patients diseased cornea is replaced by the donors healthy clear cornea. Prospective study of deep anterior lamellar keratoplasty using acellular porcine cornea the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. A clear advantage of this form of lamellar keratoplasty over penetrating keratoplasty is that it replaces only the diseased portion of the cornea. Femtosecond laser settings, technique, uncorrected visual acuity ucva, bestcorrected visual acuity.
Penetrating keratoplasty pk has been considered as the definitive procedure for the treatment of keratoconus over the past few decades 1, 2. Types of keratoplasty based on the thickness of the cornea transplanted, keratoplasty can be divided as. A slightly larger graft is harvested by superficial keratectomyon the same cornea or contralateral cornea. Melles gr, lander f, beekhuis wh, remeijer l, binder ps. Keratoplasty an operation involving corneal grafting. However, it can be complicated by allograft endothelial rejection with subsequent risk of graft failure. The advantages of alk include reducing the risk of endothelial graft rejection, retaining structural integrity, and reducing potential intraoperative complications associated with open sky procedures 1. When the entire cornea is replaced it is known as penetrating keratoplasty and when only part of the cornea is replaced it is known as lamellar keratoplasty. Review quote overall, this is an exceptionally wellproduced book. In, terry and ousley introduced endothelial keratoplasty ek.
Deep anterior lamellar keratoplasty dalk dalk the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Anterior lamellar keratoplasty alk replaces a scarirregularity in the front of the cornea, with a partial thickness tissue, assuming the. Lamellar keratoplasty partialthickness grafting anterior or posterior lamellar 3. Newer trends in lamellar keratoplasty last decade has seen a renewed interest in lamellar keratoplasty with several modifications to improve visual outcome. Holland section 3 ocular surface transplantation apply the latest techniques and advances in corneal disease and ophthalmology, including endothelial keratoplasty and deep anterior lamellar keratoplasty dalk. Posterior lamellar endothelial keratoplasty ento key. Using viscodissection, a lamellar keratoplasty can be performed quickly, with the donortorecipient interface just above the recipient dm, i. Lamellar keratoplasty consists of transplanting partialthickness donor cornea onto a complementary recipient bed. These targeted techniques provide faster healing, require fewer activity restrictions, and reduce the risk of.
Lamellar surgery is indicated if the pathlogy of the cornea is limited to specific layers that can be removed and replaced with clear, donor tissue. Lamellar and penetrating keratoplasty,, lamellar and penetrating keratoplasties are interventions in which total or partial transplantation of the corneal tissue is effectuated for the treatment of various diseases of the cornea that considerably decrease visual acuity. Lamellar keratoplasty was the first form of corneal transplantation ever attempted, and now has a history of over a century. Of the two procedures, keratoprosthesis predates penetrating keratoplasty by almost a century and, as such, plays an important role in the development of corneal transplantation. Posterior lamellar keratoplasty or endothelial keratoplasty ek attempting to replace endothelial pathology, the rst posterior lamellar keratoplasty plk procedure was described by barraquer in. Deep anterior lk dalk has eliminated risk of failure due to. This body of work demonstrates that use of new lamellar keratoplasty technology may offer expanded scope and better outcomes than traditional lamellar keratoplasty techniques. Also, the manuallydissected lamellar interface often has topographical irregularities that may optically degrade the bestcorrected visual. Newer types of transplants, such as endothelial keratoplasty and anterior lamellar keratoplasty, selectively replace only diseased layers of the cornea and leave healthy areas intact. However, newer forms of lamellar keratoplasty techniques have emerged in the last decade or so revolving around the concept of targeted replacement of diseased corneal layers.
Whereas perforating keratoplasty is becoming a common operation both in the united states and in europe and gives satisfactory results in the hands of experienced ophthalmic surgeons, lamellar keratoplasty is not very popular in the new world. Posterior lamellar endothelial keratoplasty nicoletta fynnthompson dimitri t. Keratoplasty definition of keratoplasty by the free. Methods in this singlecentre retrospective study, 48 consecutive patients with herpes simplex keratitis and having undergone dalk using either big bubble technique or manual lamellar dissection, between. A noncomparative case series of 14 eyes patients with various stromal corneal diseases underwent alk with a femtosecond laser. The histories of keratoprosthesis and corneal allograft penetrating keratoplasty are complex and intimately intertwined. To describe the initial outcomes and safety of anterior lamellar keratoplasty alk assisted by a femtosecond laser for stromal corneal pathology. With the development of surgical microscopes, microfilament sutures, a standardized eye banking system, and antirejection medications, the technique has evolved into a highly sophisticated and effective procedure for. Eyeworld penetrating keratoplasty in the era of lamellar. Lamellar keratoplasty an overview sciencedirect topics.
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