Lamellar approach to penetrating keratoplasty may improve outcomes

FORLI, Italy — A “nut-and-bolt” corneal graft configuration shows promise for improving visual acuity and quickening recovery time after penetrating keratoplasty.

Massimo Busin, MD, performed this modified penetrating keratoplasty (PK) technique on eight eyes with endothelial decompensation. Instead of performing the procedure with a standard PK technique of “cutting the donor disc with a perfect margin to fit into a perfect hole,” Dr. Busin used a modified wound configuration that involves manual dissection.

“We combined the optical superiority of PK with the wound-healing advantages of lamellar keratoplasty,” Dr. Busin said.

In the nut-and-bolt procedure, a trephine is used to make a 0.3-mm-deep incision 7 mm in diameter in the donor button, and manual dissection is used to extend the innermost layer of the button to a 9-mm diameter. This procedure is repeated in a similar way in the host cornea.

The donor button is then positioned by sliding its peripheral wing under the 1-mm wide stromal lip of the recipient bed. Four 10-0 nylon cardinal sutures are placed, followed by a single 10-0 nylon running suture. The cardinal sutures are then removed.

The running sutures were removed 3 months postop. One month after suture removal, best corrected visual acuity improved to 20/60 or better in six eyes. Refractive astigmatism improved to +4 D or less in all eight eyes.

“Despite the limited number of patients, the preliminary data suggest that this technique holds great promise,” Dr. Busin said. His results are published in the February issue of Archives of Ophthalmology.