Abstract
Purpose:
To describe four cases by two different surgeons in which tears or tissue damage occurred during surgeon-performed preparation of the posterior lamellar corneal lenticule in post-laser assisted in situ keratomileusis (LASIK) corneal donor tissue for Descemet stripping automated endothelial keratoplasty (DSAEK).
Methods:
In this retrospective case series, all donor corneal tissues had previously undergone LASIK surgery. In all cases, a Moria® artificial anterior chamber maintainer (Moria, Doyleston, PA) and a Moria® ALTK microkeratome (300-um-depth) was used by the surgeon to separate the lamellar corneal tissue.
Results:
In all four cases, the post-LASIK corneal donor tissues were torn or damaged during preparation. In two cases, large tears of the posterior lamella occurred during surgeon preparation of the donor lenticule with a microkeratome, and the tissue was deemed unusable. One case was subsequently canceled immediately prior to planned DSAEK; in the second case, an additional donor cornea was available and was successfully transplanted. In the third and fourth cases, the tissue was damaged but was deemed usable. A button-hole perforation occurred in the anterior lamellar cap of the third case, and a linear paracentral ridge was inadvertantly created on the posterior lamella of the donor tissue in the fourth case.
Conclusions:
While published literature supports use of post-LASIK donor corneal tissue in DSAEK, we believe that our cases demonstrate a need for caution in surgeon preparation of post-LASIK donor corneal tissue. To avoid tissue waste and cancelled procedures, we recommend post-LASIK donor tissue be prepared in the laboratory prior to the planned procedure. As more potential corneal donors undergo LASIK each year, effective preparation of post-LASIK donor corneal tissue will become an increasingly important consideration.
Keywords: 479 cornea: clinical science •
683 refractive surgery: LASIK •
741 transplantation