Changing techniques and indications for lamellar keratoplasty

Area of Science:

• Ophthalmology
• Surgical Techniques
• Corneal Transplantation

Background:

• Lamellar keratoplasty (LK) has seen a global decline in recent decades.
• Microsurgeons need to adapt to evolving technical procedures and indications for lamellar grafting.
• A historical review of 608 LKs performed between 1946-1995 at the University Medical School of Debrecen, Hungary, was conducted.

Purpose of the Study:

• To analyze the historical trends and changing indications of lamellar keratoplasty.
• To identify factors contributing to the evolution of lamellar grafting techniques and patient selection.
• To provide insights into the current main indications for lamellar keratoplasty.

Main Methods:

• Retrospective analysis of 3889 keratoplasties, including 608 lamellar keratoplasties (LKs), performed from 1946 to 1995.
• Categorization of LKs into three periods based on surgical advancements: 1946-1960 (biosutures, no microscope), 1961-1979 (microsurgery), and 1979-1995 (modern techniques).
• Evaluation of leading indications for LK in each period, including corneal scars, chemical burns, and recurrent pterygia.

Main Results:

• Early LKs (1946-1960) primarily treated corneal scars (leukomas) using basic materials without microscopes.
• Advancements in microsurgical procedures and materials (1961-1979) led to more sophisticated LK techniques.
• Later periods (1979-1995) saw precision lamellar grafting with improved techniques, and a shift in indications towards immediate keratoplasty post-chemical burns and sclerokeratoplasty for pterygia.

Conclusions:

• The changing indications for lamellar keratoplasty are attributed to new technical procedures, increased medical knowledge, improved immunological testing, and enhanced postoperative therapy.
• Lamellar keratoplasty remains a relevant procedure, with indications evolving to address specific complex corneal conditions.
• Continued innovation in surgical techniques and understanding of corneal diseases will likely further shape the future of lamellar keratoplasty.