Anterior Lamellar Keratoplasty Research Articles

National Survey on Corneal Transplantation in Japan.

To report the results of a national survey on corneal transplantation in Japan. The Japan Cornea Society conducted a national survey on corneal transplantation performed from 2017 to 2019. Data from various institutions were collected through an online database and subsequently analyzed. In total, 4951 cases from 44 facilities were documented. The leading cause of corneal transplantation was corneal edema (CE), which accounted for 39.3% of cases, followed by repeat keratoplasty at 27.7%. Among CE cases, postcataract surgery was the most prevalent (25.1%), followed by postglaucoma surgery (20.8%) and laser iridotomy-induced CE (18.2%). Fuchs endothelial corneal dystrophy was the fourth most common cause (10.9%). Regarding surgical methods, Descemet stripping automated endothelial keratoplasty was the most common, used in 41.3% of procedures, followed by penetrating keratoplasty at 37.1%. Deep anterior lamellar keratoplasty and Descemet membrane endothelial keratoplasty were used in 8.1% and 2.6% of cases, respectively. One year after transplantation, graft clarity was maintained in 80.5% of cases, and regrafting was necessary in 15.2% of instances. The national survey reveals that CE is the most frequent indication for corneal transplantation in Japan. Increases in cases from glaucoma surgery and Fuchs endothelial corneal dystrophy were noted among patients with CE. Endothelial keratoplasty, especially Descemet stripping automated endothelial keratoplasty, is now the preferred surgical technique for these transplants.

Indications and Current Surgical Techniques for Keratoplasty: A 10-year Review from 2011 through 2020 at a Tertiary Referral Hospital in Thailand

Objective: To report the indications and current trends in surgical techniques for keratoplasty over 10 years at Siriraj Hospital. Materials and Methods: We retrospectively reviewed the medical records of hospitalized patients who underwent keratoplasty from 2011 to 2020. The collected data comprised demographics, indications for keratoplasty, and surgical techniques used. Results: A total of 754 eyes were included. Active infectious keratitis was the most common indication (26.1%), followed by bullous keratopathy (20.8%) and regraft (19.2%). There was no significant change in indications for keratoplasty between the first 5-year period and the second 5-year period. Fungal keratitis remained the most common etiology for keratoplasty. Penetrating keratoplasty (PKP) was the most common procedure overall (90.7%), followed by endothelial keratoplasty (EK; 5.7%) and deep anterior lamellar keratoplasty (DALK; 3.6%). However, surgical techniques used in the second 5-year period differed significantly from those in the first 5-year period (P < 0.05). The use of PKP decreased from 96.0% to 86.7%; however, EK increased from 1.5% to 8.9%, while DALK rose slightly from 2.5% to 4.4%. Conclusion: Active infectious keratitis was the most common indication for keratoplasty, followed by bullous keratopathy and regraft. These indications may be reduced through collaborative efforts among government leaders, public health officers, and ophthalmologists. PKP remained the most common surgical technique due to the high incidence of infectious keratitis. However, the use of lamellar keratoplasty, including EK and DALK, significantly increased for other indications. Descemet membrane endothelial keratoplasty was performed mostly in eyes with Fuchs endothelial dystrophy.

Ten-year outcomes of repeat keratoplasty for optical indications

AimTo analyze the clinical outcomes of repeat keratoplasties following a failed primary optical keratoplasty in an Asian population.MethodsIn this prospective cohort study, clinical data of consecutive patients who had repeat keratoplasty at Singapore National Eye Centre from 2007 to 2020 were recorded from our ongoing Singapore Corneal Transplant Registry.ResultsA total of 284 first regrafts (181 Descemet stripping automated endothelial keratoplasty (EK), 63 penetrating keratoplasty (PK), 21 Descemet membrane endothelial keratoplasty, and 19 deep anterior lamellar keratoplasty (DALK)) were analyzed. Graft rejection (38.4%) and late endothelial failure (15.8%) were the main causes of initial graft failure. PK/EK and EK/EK had better one-year postoperative best corrected visual acuity compared to PK/PK (p = 0.006 and p < 0.001 respectively). Kaplan–Meier 10-year cumulative regraft survival probabilities were 69.2% for PK/EK, 52.8% for EK/EK, and 43.1% for PK/PK. Regraft survival was 100% for DALK/PK, DALK/DALK, and DALK/EK at three to 5 years. Log-rank test showed higher survival of PK/EK compared to PK/PK (p = 0.002) and EK/PK (p = 0.009), and of EK/EK compared to PK/PK (p = 0.003) and EK/PK (p = 0.005). High-risk regrafts had significantly lower 10-year survival probabilities compared to non-high-risk regrafts (p = 0.045). Cox multiple regression analysis showed male gender (p = 0.023), PK regraft (p = 0.003), regraft rejection (p = 0.003), and initial graft indications of pseudophakic bullous keratopathy (p = 0.005) and aphakic bullous keratopathy (p = 0.004) to be risk factors for regraft failure, while longer time to regraft was associated with decreased risk of failure (p = 0.013).ConclusionPerforming EK for failed optical PK or EK significantly improved regraft survival compared to repeat PK. Regrafts performed for failed initial DALK grafts did well regardless of type.

Long-term outcomes of corneal transplantation: a review of 8,378 patients

PurposeTo analyze the outcomes of corneal transplantation procedures over a 13-year period at Farabi Eye Hospital, Tehran, Iran, to identify trends and determinants influencing the frequency and success of primary and re-transplantations.MethodsUtilizing a comprehensive dataset from the hospital’s Hospital Information System, the study reviewed the records of 8,378 patients who underwent corneal transplants between 2009 and 2022. This analysis included demographic information, surgical details, and follow-up data. Statistical methods were applied to assess the impact of variables such as age, gender, surgeon experience, and surgical techniques on the likelihood of re-transplantation.ResultsOf the 8,378 transplants, 7,660 (91.4%) were primary procedures while 718 (8.6%) involved re-transplantation. The most common primary transplant was penetrating keratoplasty (PKP, 50.3%), followed by Descemet’s stripping endothelial keratoplasty (DSAEK, 29.3%), and deep anterior lamellar keratoplasty (DALK, 18.5%). Analysis revealed no significant association between re-transplantation rates and patient gender or nationality. Older recipient age correlates with higher re-transplantation rates, likely due to reduced regenerative capacity and increased comorbidities in older patients. Pre-transplant comorbidities (e.g., keratoconus, ulcers), concurrent surgeries (e.g., vitrectomy), and prior procedures (e.g., glaucoma surgeries, IOL implantation) significantly increase re-transplantation risk, likely due to additional ocular stress and inflammation.ConclusionThe study highlights the importance of patient age, surgeon experience, and the choice of surgical technique in the success rates of corneal transplants. These factors are crucial for optimizing patient outcomes and minimizing the necessity for re-transplantations.

Modified descemet's stripping automated endothelial keratoplasty (DSAEK) after failed visco‐assisted dalk: Case report

Aims/Purpose: This case report aims to describe the posterior lamellar approach to manage stromal interface irregularity after deep anterior lamellar keratoplasty (DALK).Methods: A 42‐year‐old woman previously underwent DALK with visco‐bubble failed for keratoconus associated with intraoperative perforation. One year after surgery, she presented to our center with loss visual acuity. The recipient bed appeared wrinkled and opaque. The anterior optical surface was regular, with low and regular astigmatism. Endothelial cell density (ECD) could not be assessed. The planned surgical procedure consisted of a modified small diameter (7mm) DSAEK technique, in which only the small optic zone was replaced, resulting in a two‐piece mushroom graft configuration.Results: Corneal clarity was restored and complete attachment of the donor lamella was achieved. Postoperative best‐ corrected visual acuity (BCVA) reached 20/20. No intraoperative or postoperative complications were reported.Conclusions: To achieve the clearance of the recipient bed in eyes that have undergone manual DALK, the least invasive surgical strategy should be planned, preserving the healthy corneal tissue of the patient. Small diameter posterior lamellar keratoplasty has a lower incidence of postoperative complications, decreases immunological risk and accelerates functional recovery

A retrospective analysis of patients undergoing keratoplasty in a tertiary care center

Purpose: The purpose of the study was to study keratoplasty indications and outcomes at a tertiary care center in Western Vidarbha. Subjects and Methods: It is a retrospective cross-sectional study in which medical records of all patients undergoing keratoplasty at tertiary care in Western Vidarbha, Maharashtra, India, between October 2021 and October 2023, with a minimum follow-up period of 6 months were reviewed. Data were represented as numbers, percentages, and means. Study Parameters: Indications, surgical procedures, and outcomes of all surgeries collected and studied. Main Outcomes: Graft survival and visual acuity. Results: One hundred cases of keratoplasty were recorded during the study period. Total (33) optical keratoplasties, (41) therapeutic/tectonic keratoplasties, (11) descemet stripping endothelial keratoplasty (DSEK), and (15) deep anterior lamellar keratoplasty (DALK) were included. Out of those, 15 grafts survived and 79 grafts failed. Regrafting was done in six cases. Conclusion: Fifteen percent graft survival, visual acuity improved in 30% of patients of optical KP, 28% of patients of DSEK, and 13% of patients of DALK. The most common indication for keratoplasty was a perforated corneal ulcer. Graft failures are seen in infected and rheumatoid arthritis cases commonly. Postoperative complications occurred in 73% of cases. The outcome was better in optical keratoplasty patients than in therapeutic.

Impact of residual stromal thickness on the outcomes of manual deep anterior lamellar keratoplasty

Aims/Purpose: To analyze how postoperative outcomes of manual deep anterior lamellar keratoplasty (DALK) are influenced by the thickness of the residual stromal bed of the recipient, and to explore predictive factors for this parameter.Methods: This is a retrospective case series of patients affected by keratoconus undergone manual DALK. Best spectacle‐corrected visual acuity (BSCVA) and tomographic parameters were evaluated preoperatively (T0) and postoperatively after complete suture removal (1 year, T1). The residual stromal bed of the recipient at T1 was assessed using the “flap thickness” module of CASIA SS‐1000 optical coherence tomography (Tomey, Tokyo, Japan). Measurements were performed at the center of the graft and at 12 peripheral points, 2 mm inside the margin of the corneal graft, along 6 different meridians equally spaced at 30 degrees. Then, mean peripheral thickness was calculated.Results: Data from 40 eyes undergone manual DALK were evaluated. BSCVA significantly improved at T1 (1.11 ± 0.55 LogMAR [95% CI, 0.94‐1.28] vs 0.17 ± 0.16 LogMAR [95% CI, 0.12‐0.22]). A significant linear correlation was found between postoperative BSCVA and the mean apical thickness of the residual stromal bed (72.85 ± 27.77 μm [95% CI, 64.24‐81.46]; r = 0.48, p = 0.002), but not with the mean peripheral thickness of the residual stromal bed (78.47 ± 25.32 μm [95% CI, 70.62‐86.31]; r = 0.28, p = 0.09). Multivariate regression analysis found mean posterior and anterior keratometry (K) readings of the axial power map to be the strongest predictive factors for the apical thickness of the residual stromal bed (R2 = 0.32, p < 0.001).Conclusions: Postoperative BSCVA is significantly correlated with the apical thickness of the residual stromal bed. The preoperative mean posterior and anterior K readings may be predictors of the postoperative apical thickness of the residual stromal bed.

Effect of selective suture removal on graft astigmatism after corneal transplantation in keratoconus

Background: Selective suture removal has been demonstrated to be effective in reducing post-keratoplasty astigmatism, while the remaining sutures are left in place. Existing studies typically focus on outcomes immediately after selective suture removal, without delving into the final suture-out keratometric astigmatism. Objectives: To examine the impact of selective suture removal on corneal graft astigmatism following keratoplasty in keratoconus and identify potential factors associated with the changes in graft astigmatism after suture removal. Design: Retrospective, comparative interventional case series. Methods: The study included 118 consecutive eyes of 118 cases that underwent corneal transplantation for keratoconus and had a keratometric astigmatism of ⩾4 D. One or two interrupted sutures corresponding to the steep meridian were removed per session. Patients were re-evaluated at 1 to 2-month intervals, repeating the procedure until achieving a keratometric astigmatism of <4.0 D or no interrupted sutures remained in the steep meridian. Results: The mean recipient age was 28.4 ± 8.4 years. A total of 234 selective suture removals were performed, with a mean of 2.0 ± 1.1 removals per eye. Pre-suture removal keratometric astigmatism significantly decreased from 6.3 ± 2.0 D to 3.91 ± 2.23 D after the completion of selective suture removal ( p < 0.001). This value was significantly increased to 5.45 ± 2.93 D after all suture removal ( p < 0.001). Higher pre-suture removal astigmatism and deep anterior lamellar keratoplasty were associated with a more favorable response to selective suture removal. Conclusion: Selective suture removal effectively modifies graft curvature to reduce post-keratoplasty astigmatism in keratoconus patients. However, its efficacy markedly diminishes after all sutures are removed. This procedure is particularly effective in patients with higher pre-suture removal astigmatism and those undergoing deep anterior lamellar keratoplasty.

Dalk – when and how

Deep anterior lamellar keratoplasty (DALK) is a surgical procedure that involves replacing the anterior portion of the cornea with donor tissue while preserving the patient's endothelium. This technique has gained popularity in recent years as an alternative to traditional penetrating keratoplasty (PK) due to its potential advantages in terms of visual outcomes, graft survival and reduced risk of endothelial rejection.The decision to perform DALK in keratoconus is based on various factors, including the keratometric readings, corneal thickness, corneal clarity and RGP tolerability.Surgical technique plays a critical role in the success of DALK. Several approaches have been described to perform the DALKs; the big bubble technique is considered the most convenient for all surgeons. Other techniques were used according to the associated pathology.This presentation is a quick journey into DALK indications and various techniques used in eyes with keratoconus.

Delayed spontaneous resolution of a double anterior chamber following deep anterior lamellar keratoplasty (DALK)

Abstract Background This study reports a rare case of delayed spontaneous resolution of double anterior chambers (AC) resulting from non-rhegmatogenous Descemet membrane detachment (DMD) after deep anterior lamellar keratoplasty (DALK). Currently, management guidelines for this condition have not been established. Case presentation A 65-year-old woman with lattice corneal dystrophy underwent uncomplicated DALK, during which an unrecognized type 2 big bubble was present. On postoperative day 1, a total DMD was observed, and descemetopexy was attempted. After an unsuccessful air-filled descemetopexy, we opted for observation without further intervention. Spontaneous reattachment of Descemet membrane with a clear cornea was achieved at 3 months postoperatively. The endothelial cell count was 2,165 cells/ mm2. Conclusions The spontaneous resolution of double AC in patients with DMD without visible perforation after DALK suggests that a “wait and observe” approach can be a reasonable and effective management strategy.

Penetrating keratoplasty versus deep anteriror lamellar keratoplasty for macular corneal dystrophy: A meta-analysis.

Systematic review and meta-analysis We assessed the efficacy of deep anterior lamellar keratoplasty (DALK) and penetrating (PK) for macular corneal dystrophy (MCD) We searched on 4 databases for articles published up to the end of April 2024. The study's outcome was postoperative visual acuity and other factors that may affect visual outcomes (e.g., spherical equivalent and postoperative complications). Meta-analysis was performed using random-effects or fixed-effect model according to the heterogeneity. We included 6 studies (1 RCT and 5 retrospective studies) comparing DALK (139 eyes) and PK (507 eyes) for MCD. No significant differences were found between the two procedures in uncorrected visual acuity, best-corrected visual acuity, and spherical equivalent (p = 0.58, 0.11 and 0.2, respectively). The risk of graft rejection was significantly higher in the PK group than in the DALK group (RR = 0.33; P = 0.001); however, MCD recurrence results were considerably higher in the DALK group than in the PK group (RR = 2.69, p < 0.001). The risk ratio for complications and graft survival have no significant difference between the two interventions (p = 0.9 and 0.62, respectively). Among the studies reviewed, 5 had a moderate risk of bias, while the remaining had a high risk. Our results showed that both PK and DALK have comparable outcomes of postoperative visual acuity, spherical equivalent, graft survival, and complication rate when treating MCD. Although the PK group had a higher rate of graft rejection, the DALK group had a higher recurrence rate.

Retrospective Clinical Outcomes of Keratoplasty Using Human Donor Corneas Preserved in Eusol-C Hypothermic Storage Medium.

Objective: To evaluate the clinical outcomes of cornea transplantation (penetrating keratoplasty, Descemet membrane endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty, and deep anterior lamellar keratoplasty) using donor corneas stored in Eusol-C hypothermic storage medium compared to corneas stored in organ-culture. Methods: The clinical outcomes of 92 patients who underwent corneal transplantation with human donor corneas stored in Eusol-C medium at 2-8 °C were retrospectively evaluated. The control group consisted of 169 patients who received corneas organ-cultured at 31 °C. Donor age, sex, death-to-preservation time, and storage time were recorded. Endothelial cell (EC) density (ECD), EC mortality, and EC morphology scores were evaluated during storage in both groups. Complication rates, visual outcomes, and corneal transparency were monitored for up to six months. Results: The mean storage in Eusol-C time was 7.7 ± 2.5 days, while organ-culture time was 14.2 ± 4.0 days. In the Eusol-C group, ECD was 2398 ± 354 cells/mm2, with an average EC morphology score of 3.4 ± 0.7/4. Approximately 28% of the corneas in the Eusol-C group had no EC mortality. In the organ-culture group, ECD was 2256 ± 328 cells/mm2, with an average EC morphology score of 3.5 ± 0.5/4, and 42% were devoid of EC mortality. No complications, such as re-bubbling, were observed in both groups during surgery. Transparent corneas were achieved in 81.3% of the Eusol-C group the day after surgery. Mean corrected distance visual acuity (CDVA) at 3 and 6 months was 4.5 ± 4.0/10 and 5.4 ± 3.7/10 for the Eusol-C group and 5.0 ± 2.9/10 and 5.7 ± 2.8/10 for the organ-culture group, with no statistical differences observed between the groups. No graft failure was observed up to three months. Graft rejection occurred in the Eusol-C group and in the organ-culture group in, respectively, one and two cases at the six-month follow-up. Conclusions: Comparable surgical outcomes were achieved with donor corneas stored in both hypothermic Eusol-C and organ-culture media.

Outcomes of staged conjunctival flap and corneal transplantation for infectious keratitis resistant to medical treatment

Background/AimsTo explore the outcomes of conjunctival flap (CF) followed by keratoplasty in patients with severe infectious keratitis (IK) unresponsive to medical treatment.MethodsThis is a retrospective monocentric study including 29 eyes...

Machine learning methods to identify risk factors for corneal graft rejection in keratoconus

Machine learning can be used to identify risk factors associated with graft rejection after corneal transplantation for keratoconus. The study included all keratoconus eyes that underwent primary corneal transplantation from 1994 to 2021. Data relating to the recipient, donor, surgery, and postoperative course that might be associated with the occurrence of a graft rejection reaction were compiled. This study used five supervised learning algorithms including artificial neural network, support vector machine, gradient boosting, extra trees classifier, and random survival forests to select the most predictive factors for graft rejection. A total of 1214 consecutive eyes of 985 keratoconus patients were included in the study, and the technique of keratoplasty included penetrating keratoplasty in 574 eyes (47.3%) and deep anterior lamellar keratoplasty in 640 eyes (52.7%). The overall prevalence of first graft rejection was 28.1%. All five models had similar ability in identifying predictive factors for corneal graft rejection. Technique of keratoplasty was associated with an increased risk of graft rejection in all models. Other identified risk factors included patient age, keratoplasty in the fellow eye, donor age, graft endothelial cell density, duration of corticosteroid application, time from keratoplasty to complete suture removal, and suture-associated complications. It is advisable that in the absence of any contraindication, post-transplant keratoconus eyes receive a low dose topical corticosteroid until all sutures are removed.

Intraoperative Optical Coherence Tomography (OCT)-Guided Femtosecond Laser-Assisted Descemet Membrane Endothelial Keratoplasty (iFAD).

We describe retrospectively the indications and outcomes of nine patients who present with varying degrees of deep posterior stromal scarring or endothelial failure following deep anterior lamellar keratoplasty (DALK). These patients underwent a surgical strategy coined Intraoperative Optical Coherence Tomography Guided Femtosecond Laser-Assisted Descemet Membrane Endothelial Keratoplasty (iFAD). This strategy can be used to address suboptimal visual outcomes following primary DALK. Patients undergoing iFAD first had femtosecond laser-assisted trephination of the underlying posterior lamella using the liquid keratoplasty system on the Femto LDV Z8 platform (Zeimer Ophthalmic Systems AG, Port, Switzerland). A Descemet Membrane Endothelial Keratoplasty (DMEK) graft was subsequently transplanted in place of the removed lamella. Out of nine cases, major indications for seven included post-infective, blepharokeratoconjunctivitis (BKC) and deep stromal scarring related to stromal dystrophy. The remaining two had endothelial failure following primary DALK. The main benefits of this surgical approach are (1) Utilization of integrated real-time iOCT on the femtosecond laser platform allows for precise calibration of a wide range of vertical posterior trephination depths (96-329 microns) from the endothelial surface. (2) Femtosecond laser trephination utilizing a non-applanation liquid interface preserves trephination geometries and maximises precision-based surgical outcomes. (3) iFAD is a viable and straightforward technique for surgeons addressing patients who might otherwise require complex surgery to address residual deep stromal scars post-DALK.

Comparison of clinical outcomes, complications and patient satisfaction following deep anterior lamellar keratoplasty and penetrating keratoplasty

BackgroundKeratoplasty is a surgical procedure in which a damaged or diseased cornea is replaced with healthy donor tissue, thereby restoring vision. Recent advancements have led to the replacement of penetrating keratoplasty (PKP) with the more selective deep anterior lamellar keratoplasty (DALK) procedure, especially for treating keratoconus. Although DALK typically has a shorter recovery time, less pain and a lower risk of rejection, PKP is still being performed for more severe corneal diseases. A comparative study of clinical profiles, treatment outcomes and patient-reported satisfaction will provide valuable insights into the cost-effectiveness, impact on quality of life and ability of each procedure to treat different pathologies of the cornea. Here, we aimed to compare the clinical and subjective outcomes of DALK with those of the PKP at a single center in the Kingdom of Saudi Arabia.MethodsThis retrospective cohort study included eyes that underwent either PKP or DALK from January 2017 to January 2021. The demographic features, indications, best corrected visual acuity (BCVA) and complications of the patients were recorded for both groups, analyzed and compared. A subgroup of eyes with keratoconus was analyzed separately and compared to the larger group. A 6-item survey was conducted via telephone to assess patient satisfaction and expectation, and the results were compared between the two procedures. The chi-square test or Fisher’s exact test for categorical variables or the t test or Kruskal‒Wallis test for continuous variables were used as appropriate for all comparisons, and the level of significance was set at α = 0.05.ResultsA total of 97 patients were included. PKP and DALK were performed on 63 and 39 eyes, respectively. Patients who underwent DALK were younger (mean ± standard deviation 31 ± 10.82 years versus 43 ± 26.89 years for patients who underwent PKP). The most frequent indication for PKP was keratoconus (35.5%); however, in 97.4% of the eyes undergoing DALK, the indication was keratoconus. In both groups, visual acuity and refractive error improved, but the postoperative corrected distance visual acuity in the DALK group (0.3 log MAR) was noticeably greater than that in the PKP group (0.6 log MAR). Compared with PKP, DALK may carry a lower risk of early graft edema and rejection. Overall, the reported postoperative patient satisfaction was similar for both procedures.ConclusionThe findings highlight the effectiveness of PKP and DALK in improving visual acuity and emphasize the importance of considering patient-reported outcomes in evaluating success. DALK has been demonstrated to be beneficial for protecting the corneal endothelium and lowering the risk of complications and graft rejection.

Eccentric Superficial Anterior Lamellar Keratoplasty for Bilateral Limbal Stem Cell Deficiency.

To describe and report the outcomes of allogeneic eccentric superficial anterior lamellar keratoplasty (SALK), a novel surgical technique, in the management of total bilateral limbal stem cell deficiency (LSCD). Data were collected retrospectively on all patients with total bilateral LSCD who underwent SALK. Previous surgery, preexisting glaucoma, conjunctivalization, vascularization, lens status, and preoperative best-corrected visual acuity (BCVA) were collected from medical notes. Fifteen eyes underwent eccentric SALK between November 2018 and October 2021. The average age of patients at the time of SALK was 50.3 (SD ± 21.0). There were 4 male and 11 female patients, 9 left eyes and 6 right eyes. The mean difference between pre- and post-BCVA scores were 0.43 LogMAR (95% CI, 0.23-0.63). Ten patients noted an improvement in the features of LSCD with an improvement in BCVA. Five cases were deemed a complete success with a complete resolution of corneal epithelium, no recurrence of LSCD features and an improvement in BCVA. Patients who developed fungal keratitis had poor outcomes. This study describes a new surgical technique of eccentric SALK to treat anterior stromal opacity and restore limbal stem cell function without systemic immunosuppression. The surgery improves the vision in most patients. However, in this complicated patient group, close postsurgical management is vital to recognize complications and intervene with treatment as needed.

Corneal Higher-Order Aberrations and Visual Acuity After Anterior Lamellar Keratoplasty in Treating Limbal Dermoid

Corneal Higher-Order Aberrations and Visual Acuity After Anterior Lamellar Keratoplasty in Treating Limbal Dermoid

Novel application of Deep Anterior Lamellar Keratoplasty for retinal detachment repair in totally opaque cornea secondary to aniridia.

We present a novel approach for managing retinal detachment in a patient with aniridia related corneal scarring precluding fundal view via a deep anterior lamellar keratoplasty. A 30-year-old female patient who had bilaterally opaque cornea, due to advanced aniridia related keratopathy presented with, experiencing flashing of light in her right eye. Examination of the retinal fundus was not possible due to the dense corneal scarring and underlying cataract. A superior bullous macula off retinal detachment was diagnosed on ultrasonography. Visual acuity at presentation was hand motions. The corneal scarring extended to the mid to deep stroma. We performed a deep anterior lamellar dissection of the opacified corneal stroma, that allowed clear visualisation of a dense cataract. The cataract was removed by phacoemulsification and IOL inserted. This allowed to proceed with repair of retinal detachment, through pars plana approach. The surgery was completed by a donor deep lamellar keratoplasty. This achieved a good fundal view to proceed with phacovitrectomy visualised through the residual corneal layers. Uneventful pars plana vitrectomy, cryotherapy and SF6 gas were performed to reattach the retina. Post-operatively the graft remains clear at 6 months with a visual acuity of 20/160 in the right eye, a level of vision the patient had not experienced for decades. Deep anterior lamellar keratoplasty offered an alternative to temporary keratoprosthesis to achieve a clear view of the retinal fundus and perform pars plana vitrectomy and repair of the retinal detachment.

Crescentic Autograft-Graft Salvage Technique for Undersized Donor Lenticules in Superficial Anterior Lamellar Keratoplasty.

To describe the use of crescentic autograft as a graft salvage technique for inadvertently undersized donor lenticules in superficial anterior lamellar keratoplasty (SALK). A prospective interventional study included 5 eyes of 4 patients who underwent SALK and had an inadvertently undersized donor lenticule. The described technique involves the preparation of a crescent-shaped graft from the host lenticule itself that is matched to fit into the remaining bare recipient stromal bed. At 6-week follow-up, the crescentic autograft was uniformly epithelized along with the donor tissue. There were no incidences of graft dehiscence, rejection, or infection. Crescentic autograft from the host lenticule offers a simple, easy-to perform, and unique technique to manage cases of undersized donor lenticules in SALK with no additional risks.