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Microkeratome-assisted lamellar keratoplasty for keratoconus: stromal sandwich
Kamil Bilgihan1, Sengül C Ozdek, Ayça Sari
1Gazi University, School of Medicine, Ophthalmology Department, Ankara, Turkey. bilgihan@med.gazi.edu.tr
Purpose:
To evaluate microkeratome-assisted lamellar keratoplasty for the treatment of keratoconus when it is not possible to correct the astigmatic ametropia with contact lenses.
Setting:
Ophthalmology Department, School of Medicine, Gazi University, Ankara, Turkey.
Methods:
This prospective study comprised 9 eyes of 7 keratoconus patients with contact lens intolerance. The donor cornea was prepared with a microkeratome and punched with a 7.25 mm or 7.50 mm trephine. Following the creation of a standard 9.0 mm corneal flap in the host cornea, the donor stromal button was implanted under this corneal flap like a sandwich. Transepithelial photorefractive keratectomy or laser in situ keratomileusis was performed when the corneal topography and refraction stabilized by the end of the sixth postoperative month. Follow-up ranged from 7 to 22 months.
Results:
All patients gained 5 or more lines (mean 7.2 lines +/- 1.6 [SD]), and no patient lost a line of vision. The mean corneal thickness was 432.7 +/- 36.1 micrometers preoperatively and 578.1 +/- 45.1 micrometers after refractive surgery.
Conclusion:
The early visual results of this surgical technique are promising and seem to be comparable to those with penetrating keratoplasty.