Microkeratome-assisted posterior keratoplasty

Abstract

Microkeratome-assisted posterior keratoplasty is a new surgical technique that may be valuable in treating patients with corneal decompensation secondary to endothelial dysfunction. A hinged anterior stromal flap is fashioned in the host cornea using a microkeratome, and the diseased posterior stroma and endothelium are resected. A complementary donor stromal button is prepared using a microkeratome and an artificial anterior chamber. The donor button is transplanted and secured with sutures, and the flap is repositioned. The flap can be lifted later to remove the sutures or to correct residual refractive errors using an excimer laser. This technique may allow the use of infant corneal donor tissue and may improve the outcomes of posterior keratoplasty.

Surgical alternatives to penetrating keratoplasty II: endothelial keratoplasty

“…Using microkeratome technology, the anterior corneal flap technique has been adopted by many investigators with various degrees of success [15][16][17][18][19][20][21][22]. The theoretical advantages of the anterior corneal flap technique include faster visual rehabilitation compared to PK, direct access to ocular structures which facilitates concomitant procedures (i.e., intraocular lens exchange, cataract extraction, iridoplasty, vitrectomy), and employment of suturing techniques familiar to the corneal surgeon.…”

“…The use of an intrastromal nylon suture to fixate the endothelial disc has the tendency to produce an oblate corneal surface, which may create a large hyperopic shift [16]. This may be managed by cutting the sutures with the argon laser, without lifting the flap, while other investigators have successfully used 10-0 vicryl [18] or 8-0 polygalactin [17] absorbable sutures with improved results.…”

“…Mean postoperative astigmatism using the anterior corneal flap technique has ranged from 1.9 to 2.9 D [12][13][14][15][16][17][18][19][20][21][22]. Busin et al obtained a mean refractive astigmatism of 2.9 D between 4 and 7 months after ''endokeratoplasty'' [17].…”

Complications après Descemet stripping automated endothelial keratoplasty : étude monocentrique sur 32 yeux

“…Dès la fin des années 1990, différentes techniques de kératoplastie lamellaire postérieure voient le jour : techniques automatisées et assistées par microkératome [2][3][4][5] ou techniques dites « manuelles » par création d'une poche cornéenne stromale sur le receveur [6,7]. Toutes ces techniques nécessitent une découpe du stroma cornéen postérieur du receveur qui est souvent sain dans les pathologies endothélio-descemétiques.…”

In Vivo Femtosecond Laser-Assisted Posterior Lamellar Keratoplasty in Rabbits

“…Microkeratome-assisted techniques require corneal surface incisions and often sutures, which can lead to high astigmatism and epithelial ingrowth. [13][14][15][16] Posterior lamellar keratoplasty (PLK) or deep lamellar endothelial keratoplasty involve creation of a lamellar corneal pocket through a limbal-scleral incision. [17][18][19][20] An intralamellar trephine or highly curved scissors are used to excise the posterior stromal button containing the diseased endothelium.…”