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E.P. Herlihy, P.N. Youssef, M.V. Netto, T.T. Shen; Management of a Severe Corneal Scar Using Lamellar Keratoplasty With a Standard Hansatome Microkeratome and a Frozen Globe . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4380.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To report the management of a severe corneal scar at the LASIK flap interface using lamellar keratoplasty with a Hansatome microkeratome and subsequent LASIK enhancement to correct residual astigmatism. Methods: Case report of a 56–year–old man who developed a severe Pseudomonas corneal ulcer two years after uncomplicated LASIK surgery. On presentation, visual acuity in the affected eye was light perception only; hypopyon and severe DLK were noted. The corneal ulcer resolved after aggressive treatment with fortified antibiotics as well as topical and oral steroids. However, a dense corneal scar at the level of the LASIK flap interface resulted and extended into the visual axis. A lamellar keratoplasty was performed to remove the corneal scar at the LASIK flap interface. Using standard technique with a Hansatome microkeratome (Bausch & Lomb), a 180 micron flap was created to remove the old LASIK flap and the corneal scar from the previous infection. A donor flap from a whole globe was created using an identical Hansatome microkeratome arrangement. A superior hinge was then cut in the host and in the donor tissue. The donor flap was sutured to the host stromal bed, with the superior hinge well matched. Postoperatively, the eye was treated with a bandage contact lens, antibiotics and steroids. Results:At post–operative week one, the transplanted LASIK flap was completely epithelialized. There was no evidence of epithelial ingrowth. Selective suture removal began at post–op week three. Residual corneal astigmatism (4.5 D) was later treated with standard LASIK enhancement technique by lifting the transplanted lamellar flap. Post–op management included standard bandage lens and antibiotic therapy. At post–enhancement week one the flap was well positioned and there was no evidence of striae or epithelial ingrowth. Post LASIK enhancement VA was 20/40. Conclusions: Bacterial corneal ulcer occurring after LASIK surgery may result in severe interface scar with significant decrease in vision. Using a standard Hansatome microkeratome set–up, lamellar keratoplasty can be successfully performed to eliminate the interface scar. This approach offers faster visual recovery than penetrating keratoplasty and provides the potential for post–transplant LASIK enhancement. In addition, the requirement for eye bank tissue is less strict, as the tissue may be obtained from a frozen globe.
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