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Lamellar techniques may work well in pediatric patients with corneal opacities
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BERLIN — Deep anterior lamellar keratoplasty can be successfully performed to treat corneal opacities in children, avoiding full-thickness transplantation.
"In stromal dystrophies with healthy endothelium, DALK can be an option," Ken K. Nischal, MD, said at the World Ophthalmology Congress.
In most cases, Anwar's big bubble technique or Melles' viscodissection can be used in children's eyes. In specific diseases, such as mucopolysaccharidosis, the altered fibril spacing and irregular packing do not allow injection of air or viscoelastic in the stroma.
"In these cases, I use high-frequency ultrasound to try and work out the depth of the cornea, and then cut the host button using a Hessburg-Barron trephine, which allows me to measure how deep I am cutting. Each quarter turn is 0.06 mm. So if my intended thickness is 700 µm, I can cut down as far as I dare, and when I am at the level I want to be at, I take the trephine off. Air can then be injected in the anterior chamber to make sure that when I remove the residual stroma, I don't perforate the Descemet's," Dr. Nischal said.
Dr. Nischal has performed DALK in 13 eyes of nine pediatric patients. All eyes achieved and maintained corneal clarity.
Endothelial approaches such as Descemet's stripping endothelial keratoplasty are currently used by some surgeons in pediatric patients.
"Personally, I think we need further experience with endothelial techniques in adults before we perform them in children," Dr. Nischal said.
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