Abstract
The recent years have brought about a sea change in the field of corneal transplantation with penetrating keratoplasty being phased to newer lamellar keratoplasty techniques. In keratoconus, the aim of surgery is to augment a thin and steep cornea, and this can be achieved by using a thick lamellar donor of normal curvature, thus tectonically strengthening the cornea (which reduces irregular astigmatism and subsequent ectasia) and reducing corneal steepness (and concomitant high myopia). This is achieved by performing more superficial lamellar dissection of the recipient bed and obtaining a thicker donor lamella. Thanks to the advent of new surgical devices such as advanced microkeratome instrumentation, excimer laser, and femtosecondlaser, the results of lamellar techniques have been encouraging, with rapid visual rehabilitation and vastly reduced risk of immune-mediated transplant rejection [4].
Highlights
Keratoconus (KC) is a progressive, bilateral, but usually asymmetrical ecstatic corneal disease, characterized by progressive corneal protrusion and thinning, that leads to corneal surface distortion
Keratoplasty has developed rapidly in the past 10 years and penetrating keratoplasty (PK), a procedure consisting of fullthickness replacement of the cornea, has been the dominant procedure for more than half a century
Since anterior lamellar keratoplasty (ALK) is an extra ocular procedure, it lacks the risk associated with open sky surgery, such as expulsive hemorrhage, endophthalmitis and iris ⁄ lens damage
Summary
Outcomes have accumulated towards new interventions for keratoconus, which promise to slow down disease progression or correct the refractive defect These interventions include intracorneal ring implantation, photorefractive keratectomy, phakic intraocular lens implantation and corneal collagen crosslinking [3]. In recent years in all those cases in which corneal disease not involving the endothelium, lamellar technique has rapidly replaced penetrating grafts with better clinical results. This technique aims to selectively replace diseased corneal stroma in a way to minimize unnecessary replacement of the unaffected healthy endothelial layer.
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