This article is more than 5 years old. Information may no longer be current.
DALK preferred for severe ectasia
Click Here to Manage Email Alerts
ORLANDO, Fla. — Deep anterior lamellar keratoplasty is well-suited to most patients with severe corneal ectasia, a surgeon said here.
"When we look at doing lamellar surgery, we have basic technique options. These are different for the side-cut and the lamellar dissection," Francis W. Price Jr., MD, said at Refractive Subspecialty Day preceding the American Academy of Ophthalmology meeting.
Side-cuts can be performed manually or with a femtosecond laser. The femtosecond laser is ideal for performing difficult side-cuts, Dr. Price said.
"To my knowledge, there is no current femtosecond laser that can adequately perform a lamellar dissection in the posterior stroma," Dr. Price said. "I think you can understand that if you do endothelial keratoplasty. We know from stripping Decemet's [membrane] that the posterior stroma is very soft. There's very little collagen and I just don't think the lasers cut well there."
Disadvantages of manual trephination include inaccuracy of wound depth and difficulty cutting at a 90-degree angle at the desired depth. A "zig-zag" incision made with a femtosecond laser is more accurate in terms of incision shape and depth, Dr. Price said.
Dissection techniques are similar for DALK and penetrating keratoplasty, Dr. Price said.
DALK is the most invasive treatment for ectasia. Less invasive treatments include rigid or gas-permeable contact lenses, intracorneal rings and corneal crosslinking. Dr. Price recommended a less invasive treatment unless the patient cannot wear contact lenses, has central corneal thickness of less than 300 microns or has appreciable corneal scarring.
- Disclosures: Dr. Price has no relevant financial disclosures.