Fluid lamellar keratoplasty in keratoconus

Area of Science:

• Ophthalmology
• Corneal Surgery
• Vision Science

Background:

• Keratoconus is a progressive corneal ectasia leading to vision impairment.
• Traditional penetrating keratoplasty carries risks of rejection and requires long-term immunosuppression.
• Deep lamellar keratoplasty aims to preserve host endothelium, potentially reducing rejection rates.

Purpose of the Study:

• To evaluate the efficacy and safety of a modified fluid-assisted deep lamellar keratoplasty (DLK) technique for treating keratoconus.
• To assess visual outcomes and complication rates associated with this novel DLK approach.

Main Methods:

• A noncomparative case series involving 26 eyes of 25 patients with moderate to advanced keratoconus.
• The modified DLK technique involved intrastromal balanced salt solution injection for corneal dissection, followed by suturing a full-thickness graft (without endothelium/Descemet's membrane).
• Outcomes were assessed using spectacle-corrected visual acuity, slit-lamp biomicroscopy, corneal topography, and intraocular pressure measurements.

Main Results:

• Two cases (8.4%) required conversion to penetrating keratoplasty due to intraoperative perforation.
• In the 24 successful DLK cases, visual acuity improved significantly: 79% achieved >20/50 at 3 months, 87.5% achieved >20/40 at 6 months, and 95.8% achieved 20/30 or better by 1 year post-suture removal.
• Only one eye (4.2%) developed interface irregular astigmatism, successfully managed with contact lenses.

Conclusions:

• Fluid-assisted DLK is a safe and effective surgical option for keratoconus, particularly in bilateral cases, as it eliminates the risk of endothelial rejection.
• The procedure is technically demanding and associated with a slower visual rehabilitation period compared to other techniques.
• This modified DLK technique demonstrates good visual outcomes and a low rate of significant complications.