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Chapter-23 Two-Stage Anterior Lamellar Keratoplasty

BOOK TITLE: Surgical Techniques in Anterior and Posterior Lamellar Corneal Surgery

Author
1. Beatty Richard F
ISBN
9788180616051
DOI
10.5005/jp/books/10883_23
Edition
1/e
Publishing Year
2006
Pages
17
Author Affiliations
1. University of Colorado Health Science Center, Denver, Colorado, USA
Chapter keywords

Abstract

The concept and technique for automated lamellar therapeutic keratoplasty (ALTK) has evolved with contributions from many surgeons. Initially, it was JI Barraquer who described the use of a microkeratome to prepare both donor tissue and the recipient cornea for lamellar keratoplasty (LKP). During those early times, these microkeratomes were not readily available and were complicated to use, resulting in a few surgeons adopting the procedure. Limited success was attributed to poor predictability of the diameter, shape, and thickness of the lenticle obtained with the microkeratome. A microkeratome-assisted technique for anterior lamellar therapeutic keratoplasty in two stages has been used for vision rehabilitation in eyes with anterior and midstromal corneal pathology. The technical approach to the two-stage ALTK has been presented in this chapter and the advantages over the one-stage procedure reviewed. It is the author’s experience that the two-stage ALTK technique is the desirable approach. However, the one-stage ALTK procedure is entirely appropriate for the pediatric age group and other selected cases. Technical advances which may improve the surgical procedure include the automation of the microkeratome for a more uniform pass on the AAC and for creation of the host cornea lamellar flap. The application of laser ablation technology to corneal dissection offers potential for more precise and predictable depths of resection. It is the author’s opinion that replacement of the anterior cornea is appropriate for anterior corneal pathology. Lamellar keratoplasty avoids intraocular surgery and reduces the long-term risk of endothelial decompensation and endothelial rejection reaction, common problems with PKP surgical procedures. The two-stage ALTK procedure has proven to be a safe and reliable approach to LKP and has allowed for excellent visual rehabilitation in appropriately selected cases.

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