Azar posterior lamellar endothelial keratoplasty refers to the removal of the diseased posterior corneal layers and their replacement by partialthickness 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. 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. A clear advantage of this form of lamellar keratoplasty over penetrating keratoplasty is that it replaces only the diseased portion of the cornea. Corneal melting two weeks after pterygium excision with. Using viscodissection, a lamellar keratoplasty can be performed quickly, with the donortorecipient interface just above the recipient dm, i. Listing a study does not mean it has been evaluated by the u. Deep anterior lamellar keratoplasty dalk, which involves the removal of anterior diseased cornea while leaving deeper tissue intact, offers the. A slightly larger graft is harvested by superficial keratectomyon the same cornea or contralateral cornea. To describe the initial outcomes and safety of anterior lamellar keratoplasty alk assisted by a femtosecond laser for stromal corneal pathology. 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. Anterior lamellar keratoplasty alk replaces a scarirregularity in the front of the cornea, with a partial thickness tissue, assuming the.
When scarring or corneal disease involves the front anterior part of the cornea, there are two surgical options to consider. Anterior lamellar keratoplasty american academy of. It is an operation in which the patients diseased cornea is replaced by the donors healthy clear cornea. 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. To report the management of a case of corneal melting two weeks after pterygium. 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. Outcomes from a modified microkeratomeassisted lamellar. Presumed stromal graft rejection after automated lamellar. These include anterior lamellar keratoplasty alk techniques that aim to selectively replace diseased corneal stroma and endothelial keratoplasty techniques aiming. Penetrating keratoplasty involved full thickness of the cornea. Lamellar keratoplasty partialthickness grafting anterior or posterior lamellar 3. Occasionally, it is employed in the rehabilitation of thinned corneas or those with anterior opacification.
In, terry and ousley introduced endothelial keratoplasty ek. Femtosecond laser settings, technique, uncorrected visual acuity ucva, bestcorrected visual acuity. 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. 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. Keratoplastycorneal grafting corneal transplantation definition.
Lamellar keratoplasty consists of transplanting partialthickness donor cornea onto a complementary recipient bed. Keratoplasty an operation involving corneal grafting. 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. Types of keratoplasty based on the thickness of the cornea transplanted, keratoplasty can be divided as. Deep lamellar keratoplastyan alternative to penetrating. 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. The second operation is usually a simple lamellar keratoplasty. 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. 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. Lamellar keratoplasty was the first form of corneal transplantation ever attempted, and now has a history of over a century. Penetrating keratoplasty cornea research foundation of.
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. Posterior lamellar endothelial keratoplasty nicoletta fynnthompson dimitri t. 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. 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. Femtosecond laserassisted anterior lamellar keratoplasty. Lamellar keratoplasty an overview sciencedirect topics. Manual lamellar dissection is technically very difficult, timeconsuming, and imprecise. 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. A surgical technique for posterior lamellar keratoplasty. Penetrating keratoplasty pk has been considered as the definitive procedure for the treatment of keratoconus over the past few decades 1, 2.
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 noncomparative case series of 14 eyes patients with various stromal corneal diseases underwent alk with a femtosecond laser. Deep anterior lamellar keratoplasty dalk dalk the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Posterior lamellar keratoplasty for a case of pseudophakic bullous keratopathy.
However, it can be complicated by allograft endothelial rejection with subsequent risk of graft failure. Posterior lamellar keratoplasty or endothelial keratoplasty ek attempting to replace endothelial pathology, the rst posterior lamellar keratoplasty plk procedure was described by barraquer in. Newer trends in lamellar keratoplasty last decade has seen a renewed interest in lamellar keratoplasty with several modifications to improve visual outcome. References for an introduction to corneal transplantation. To improve visual and refractive outcomes, microkeratomeassisted lamellar keratoplasty for the treatment of keratoconus exchange of a 9. This body of work demonstrates that use of new lamellar keratoplasty technology may offer expanded scope and better outcomes than traditional lamellar keratoplasty techniques. Review quote overall, this is an exceptionally wellproduced book.
Deep anterior lamellar keratoplasty dalk full text. 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. 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. Full text get a printable copy pdf file of the complete article 4. Melles gr, lander f, beekhuis wh, remeijer l, binder ps. 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.
This process involves the use of a cookie cutter like. Also, the manuallydissected lamellar interface often has topographical irregularities that may optically degrade the bestcorrected visual. Prospective study of deep anterior lamellar keratoplasty. The concept of lamellar keratoplasty lk is not new. These targeted techniques provide faster healing, require fewer activity restrictions, and reduce the risk of. Depending on the depth of the lamellar dissection, either a full. 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. 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.
Endothelial cell loss and visual outcome of deep anterior. The histories of keratoprosthesis and corneal allograft penetrating keratoplasty are complex and intimately intertwined. Keratoplasty definition of keratoplasty by the free. Lamellar keratoplasty lk targets partial or lamellar replacement of diseased corneal tissue.