Outcomes From a Modified Microkeratome-Assisted Lamellar Keratoplasty for Keratoconus | Cornea | JAMA Ophthalmology | JAMA Network
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Sugita J, Kondo J. Deep lamellar keratoplasty with complete removal of pathological stroma for vision improvement.  Br J Ophthalmol. 1997;81(3):184-1889135380PubMedGoogle ScholarCrossref
Melles GR, Lander F, Rietveld FJ, Remeijer L, Beekhuis WH, Binder PS. A new surgical technique for deep stromal, anterior lamellar keratoplasty.  Br J Ophthalmol. 1999;83(3):327-33310365042PubMedGoogle ScholarCrossref
Anwar M, Teichmann KD. Deep lamellar keratoplasty: surgical techniques for anterior lamellar keratoplasty with and without baring of Descemet's membrane.  Cornea. 2002;21(4):374-38311973386PubMedGoogle ScholarCrossref
Anwar M, Teichmann KD. Big-bubble technique to bare Descemet's membrane in anterior lamellar keratoplasty.  J Cataract Refract Surg. 2002;28(3):398-40311973083PubMedGoogle ScholarCrossref
Busin M, Zambianchi L, Arffa RC. Microkeratome-assisted lamellar keratoplasty for the surgical treatment of keratoconus.  Ophthalmology. 2005;112(6):987-99715885782PubMedGoogle ScholarCrossref
Busin M, Arffa RC. Microkeratome-assisted mushroom keratoplasty with minimal endothelial replacement.  Am J Ophthalmol. 2005;140(1):138-14016038660PubMedGoogle ScholarCrossref
Ardjomand N, Hau S, McAlister JC,  et al.  Quality of vision and graft thickness in deep anterior lamellar and penetrating corneal allografts.  Am J Ophthalmol. 2007;143(2):228-23517258522PubMedGoogle ScholarCrossref
Bahar I, Kaiserman I, Srinivasan S, Ya-Ping J, Slomovic AR, Rootman DS. Comparison of three different techniques of corneal transplantation for keratoconus.  Am J Ophthalmol. 2008;146(6):905-91218723138PubMedGoogle ScholarCrossref
Funnell CL, Ball J, Noble BA. Comparative cohort study of the outcomes of deep lamellar keratoplasty and penetrating keratoplasty for keratoconus.  Eye (Lond). 2006;20(5):527-53215877089PubMedGoogle ScholarCrossref
Han DC, Mehta JS, Por YM, Htoon HM, Tan DT. Comparison of outcomes of lamellar keratoplasty and penetrating keratoplasty in keratoconus.  Am J Ophthalmol. 2009;148(5):744-75119589495PubMedGoogle ScholarCrossref
Watson SL, Ramsay A, Dart JK, Bunce C, Craig E. Comparison of deep lamellar keratoplasty and penetrating keratoplasty in patients with keratoconus.  Ophthalmology. 2004;111(9):1676-168215350322PubMedGoogle ScholarCrossref
Naumann GO, Seitz B, Lang GK, Langenbucher A, Kus MM. 193 Excimer laser trepanation in perforating keratoplasty: report of 70 patients [in German].  Klin Monbl Augenheilkd. 1993;203(4):252-2618114466PubMedGoogle ScholarCrossref
Alessio G, L’abbate M, Boscia F, Sborgia C, La Tegola MG. Excimer laser-assisted lamellar keratoplasty and the corneal endothelium.  Am J Ophthalmol. 2010;150(1):88-9620493467PubMedGoogle ScholarCrossref
Shousha MA, Yoo SH, Kymionis GD,  et al.  Long-term results of femtosecond laser-assisted sutureless anterior lamellar keratoplasty.  Ophthalmology. 2011;118(2):315-32320869117PubMedGoogle ScholarCrossref
Buzzonetti L, Laborante A, Petrocelli G. Standardized big-bubble technique in deep anterior lamellar keratoplasty assisted by the femtosecond laser.  J Cataract Refract Surg. 2010;36(10):1631-163620870106PubMedGoogle ScholarCrossref
Shortt AJ, Bunce C, Allan BD. Evidence for superior efficacy and safety of LASIK over photorefractive keratectomy for correction of myopia.  Ophthalmology. 2006;113(11):1897-190817074559PubMedGoogle ScholarCrossref
Price FW Jr, Price MO. Descemet's stripping with endothelial keratoplasty in 50 eyes: a refractive neutral corneal transplant.  J Refract Surg. 2005;21(4):339-34516128330PubMedGoogle Scholar
Lee WB, Jacobs DS, Musch DC, Kaufman SC, Reinhart WJ, Shtein RM. Descemet's stripping endothelial keratoplasty: safety and outcomes: a report by the American Academy of Ophthalmology.  Ophthalmology. 2009;116(9):1818-183019643492PubMedGoogle ScholarCrossref
Acar BT, Arslan OS, Buttanri IB, Sevim MS, Acar S. Comparing deep anterior lamellar keratoplasty and automated lamellar therapeutic keratoplasty in patients with keratoconus.  Jpn J Ophthalmol. 2011;55(4):327-33221633807PubMedGoogle ScholarCrossref
Springs CL, Joseph MA, Odom JV, Wiley LA. Predictability of donor lamellar graft diameter and thickness in an artificial anterior chamber system.  Cornea. 2002;21(7):696-69912352088PubMedGoogle ScholarCrossref
Shimazaki J, Shimmura S, Ishioka M, Tsubota K. Randomized clinical trial of deep lamellar keratoplasty vs penetrating keratoplasty.  Am J Ophthalmol. 2002;134(2):159-16512140020PubMedGoogle ScholarCrossref
Brierly SC, Izquierdo L Jr, Mannis MJ. Penetrating keratoplasty for keratoconus.  Cornea. 2000;19(3):329-33210832693PubMedGoogle ScholarCrossref
Noble BA, Agrawal A, Collins C, Saldana M, Brogden PR, Zuberbuhler B. Deep anterior lamellar keratoplasty (DALK): visual outcome and complications for a heterogeneous group of corneal pathologies.  Cornea. 2007;26(1):59-6417198015PubMedGoogle ScholarCrossref
Reinhart WJ, Musch DC, Jacobs DS, Lee WB, Kaufman SC, Shtein RM. Deep anterior lamellar keratoplasty as an alternative to penetrating keratoplasty: a report by the American Academy of Ophthalmology.  Ophthalmology. 2011;118(1):209-21821199711PubMedGoogle ScholarCrossref
Cheng YY, Visser N, Schouten JS,  et al.  Endothelial cell loss and visual outcome of deep anterior lamellar keratoplasty versus penetrating keratoplasty: a randomized multicenter clinical trial.  Ophthalmology. 2011;118(2):302-30920832121PubMedGoogle ScholarCrossref
Kubaloglu A, Sari ES, Unal M,  et al.  Long-term results of deep anterior lamellar keratoplasty for the treatment of keratoconus.  Am J Ophthalmol. 2011;151(5):760-76721333267PubMedGoogle ScholarCrossref
Surgical Technique
Surgeon's Corner
June 2012

Outcomes From a Modified Microkeratome-Assisted Lamellar Keratoplasty for Keratoconus

Author Affiliations

Author Affiliations: Department of Ophthalmology, Magna Graecia University, Catanzaro, Italy (Drs Busin and Scorcia); Department of Ophthalmology, Villa Igea Hospital, Forlì, Italy (Drs Busin and Zambianchi); and Fondazione Banca degli Occhi del Veneto, Venezia, Italy (Dr Ponzin).

Arch Ophthalmol. 2012;130(6):776-782. doi:10.1001/archophthalmol.2011.1546

To improve visual and refractive outcomes, microkeratome-assisted lamellar keratoplasty for the treatment of keratoconus (exchange of a 9.0-mm anterior recipient lamella with a 9.0-mm donor lamella, using a 200-μm head for the former and a 300-μm head for the latter) was modified by adding a 6.5-mm incomplete full-thickness incision in the recipient bed before suturing the donor graft in place. After complete suture removal, 1 year postoperatively, best spectacle-corrected visual acuity was 20/40 or better in 92 of 97 eyes and 20/25 or better in 67 of 97 eyes; regular astigmatism was 4.5 diopters or worse in 86 of 97 eyes; endothelial cell loss averaged 20.4%. The disruption of the recipient's architecture induced by the full-thickness circular incision makes the final corneal shape closely resemble the physiologic curvature of the donor cornea, thus optimizing postoperative refractive error and spectacle-corrected visual acuity.