Purchase this article with an account.
C. Skorpik; Therapeutic Posterior Lamellar Keratoplasty After Ulceration or Perforation. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1614.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Corneal diseases with progressive thinning are difficult to treat (tissue glue, amnion transplantation, keratoplasty). In keratoplasty results are impaired by preexisting surface disease, wound problems or high postop. astigmatism. Posterior lamellar keratoplasty leaves the patient's cornea intact and seals the affected area adding corneal tissue via anterior chamber.
Between 12/08 and 03/09 5 surgeries were performed after standard surgery/treatment had failed on these eyes: 1.:excentric descemetocele following multiple surgeries; 2.:perforated ulcer in Stevens-Johnson Syndrom; 3.:perforated ulcer after alcali burn; 4.:perforated ulcer in rheumatic disease; 5.:perforated neuroparalytic ulcer. A lamellar posterior graft (ALTK-system, 250µ) was implanted through a 3.2mm temporal incision. Graft size depended on the affected area. The graft was positioned and air inflated to enforce adherence between the lamellas.
In all cases the transplant could close the defect, respectively thicken the area with descemetocele. With additional surface protective therapy (lubricant eye drops, bandage contact lense, amnion) the thinning could be stopped and the epithelium could be closed permanently. In anterior lamellar keratoplasty or perforating keratoplasty corneal tissue is removed for adaptation of the transplant. Irregularities of the wound enforce surface problems in these cases. Closing the defect at the posterior surface leaves the patient's cornea unchanged and only closes the affected area.
In this technique thickness and configuration of the transplant can be adapted individually. The technique offers promissing advantages to standard surgical techniques.
This PDF is available to Subscribers Only