Lamellar Keratoplasty: A Literature Review

Abstract

The concept of lamellar keratoplasty (LK) is not new. 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. These include anterior lamellar keratoplasty (ALK) techniques that aim to selectively replace diseased corneal stroma and endothelial keratoplasty techniques aiming to replaced damaged endothelium in endothelial disorders. Recent improvements in surgical instruments and introduction of new techniques as well as inherent advantages such as preservation of globe integrity and decreased graft rejection have resulted in the reintroduction of LK as an acceptable alternative to conventional PK. In this review, indications, benefits, limitations, and outcomes of various anterior and posterior lamellar keratoplasty techniques are discussed.

Traumatic globe rupture after deep anterior lamellar keratoplasty—A novel management technique

“…Fifty‐four percent are posterior lamellar, 4% anterior lamellar, and 42% perforating keratoplasties, though the use of lamellar keratoplasty techniques has increased (personal communication from Prof. Dr. B. Seitz). DALK offers significant advantages over perforated keratoplasty, including reduced risk of endothelial graft rejection, preservation of host endothelium with minimal surgical trauma, and also fewer intraoperative and postoperative complications including expulsive hemorrhage, anterior synechia, postoperative endophthalmitis, and glaucoma (Espandar and Carlson, ). Owing to the lack of endothelial rejection, DALK can offer advantages for young patients with keratoconus or for patients with increased risk of rejection, such as in atopic dermatitis.…”

Corneal transplantation

“…Other options for corneal transplantation include • anterior lamellar keratoplasty, 4,5 • endothelial keratoplasty (e.g., Descemet stripping endothelial keratoplasty, Descemet membrane endothelial keratoplasty), and 4,5 • keratoprosthesis. 6 To perform an anterior lamellar keratoplasty, which replaces the stroma but leaves the Descemet membrane and endothelium, 6 the surgeon will 1. insert an eyelid speculum; 2. make a groove of the desired depth in the donor cornea and dissect it with a blade; 3. trephine the patient's cornea to the desired depth; 4. perform a lamellar resection; 5. secure the donor cornea with nonabsorbable sutures; 6. use mydriatic agents and antibiotics as needed; and 7. place an eye patch.…”

The structure and evolution of eye banking: a review on eye banks’ historical, present, and future contribution to corneal transplantation

“…7 Zirm's success was not replicated until 1914 when fellow-Austrian, Dr. Anton Elschnig, performed the second successful corneal transplant. 8 These surgical advents were followed by the development of lamellar keratoplasty (selective removal and replacement of specific corneal layers, rather than the entire cornea) 9 by a Russian Vladimir Filatov and the development of the double-bladed knife for square grafts by a Spaniard Ramon Castrovjiejo. 10 In the early years of corneal transplantation, surgeons relied on enucleated eyes from living donors with posterior segment pathology or deceased patients in public hospitals.…”