ALT safe, effective as keratoconus treatment

FORLI, Italy — Automated lamellar keratoplasty is a simple and efficient treatment for keratoconus, according to Massimo Busin, MD, in practice here. He added that patients experience fast visual rehabilitation.

“To date I have used this technique in more than 20 patients and in my hands it is the technique of choice for moderately advanced to advanced keratoconus,” Dr. Busin told Ocular Surgery News. He said therapies for keratoconus in patients with normal corneal transparency are typically glasses, contact lenses or conservative surgery, which he defines as epikeratophakia, intrastromal segment or perhaps an excimer laser procedure.

For keratoconus patients with scarred corneas, the appropriate therapy would be “destructive surgery,” meaning penetrating keratoplasty or lamellar keratoplasty, Dr. Busin said.

Using lamellar keratoplasty for keratoconus, the surgeon can rebuild the normal curvature, replace the stromal scar and preserve the endothelium. Dr. Busin said he prefers automated dissection to preserve the optical quality of the interface.

“Microkeratome-assisted lamellar keratoplasty allows patients to achieve 20/20 vision as seen with LASIK,” Dr. Busin said. He qualifies patients as suitable for this procedure if they are spectacle- or contact lens-intolerant with scarring of the cone limited to the anterior half of the stroma. The technique is contraindicated in patients with corneas thinner than 380 µm or with opacities reaching the posterior half of the stroma, Dr. Busin said.

For more on Dr. Busin's results, read the Nov. 1 issue of Ocular Surgery News.