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Chapter-62 Deep Lamellar Keratoplasty Combined with Autologous Limbal Grafting in Treating Unilaterally Severe Burnt Eye

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

Author
1. Yao Yu-Feng
ISBN
9788180616051
DOI
10.5005/jp/books/10883_62
Edition
1/e
Publishing Year
2006
Pages
9
Author Affiliations
1. Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, PR China
Chapter keywords

Abstract

DLKP combined with CLAU is an ideal surgical approach for treating unilaterally burnt eyes. This approach simultaneously restores a normal and stable ocular surface, and provides a clear central cornea with improved visual acuity. It also excludes the possibility of postoperative immunologic rejection of the epithelium and endothelium. The surgical tips for achieving successful DLKP include the use of intrastromal injection of solution for completing the deep stromal dissection, and for complete exposure of DM in the optical area, and the use of the forceps-tip stromal hooking technique that is very helpful in the dissection of the host cornea as described above. Deep lamellar keratoplasty (DLKP), a form of anterior lamellar keratoplasty (ALKP), was described as a surgical procedure to attain corneal clarity, about 2 decades ago in the early to mid-1980s. Recently, there has been a significant interest among ophthalmologists in DLKP procedure, since this type of corneal replacement retains the patient’s own endothelium and hence excludes the possibility of endothelial graft rejection; and further, it yields at least the same amount of postoperative visual recovery as compared to penetrating keratoplasty (PKP). For achieving the deep stromal dissection and baring DM for DLKP, several techniques have been developed. In this chapter, we will describe a technique of intrastromal injection of balanced salt solution (BSS) to swell the tissue that allows deep stromal dissection to remove most of the recipient’s corneal stroma. Also, a technique of forceps-tip stromal-hooking for complete exposure of DM in the optical area, following deep stromal dissection, will be illustrated in detail. We will also describe the preparation of burnt eyes for DLKP and CLAU including superficial fibro­vascular membrane removal and extensive removal of subconjunctival fibrovascular tissue. The technique of obtaining conjunctival limbal tissue from the fellow healthy eye and grafting it to the damaged eye will also be depicted. The clinical result of using cyopreserved donor cornea for grafting in this type of the surgery will be described.

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