‘Pachy-link’ provides good transplant results, surgeon says

PARIS – A pachymetry-guided nonpenetrating transplant procedure can help corneal surgeons achieve greater safety and faster recovery than with traditional lamellar procedures, according to a surgeon speaking here.

Cesar Carriazo, MD, described his pachymetry-associated laser keratoplasty procedure — which he also called PALK or “pachy-link” — here at the European Society of Cataract and Refractive Surgeons meeting.

The PALK procedure uses a series of pachymetry measurements taken in a multitude of positions on the cornea, along with computer software analysis, to give the surgeon a better idea of the shape and depth of the cornea. The surgeon can then choose the correct depth, on the order of microns, for the stromal bed in a nonpenetrating corneal transplant.

Dr. Carriazo said PALK involves creating a laser assisted lamellar keratectomy in the recipient eye by linking the pachymetric data to an excimer laser.

With the new system, Dr. Carriazo said surgeons can remove corneal damage to a depth of 100 µ in the stroma.

The method involves several steps, Dr. Carriazo said. First, the surgeon maps the anterior and posterior surfaces of the patient’s cornea with topography. Corneal pachymetry is then used to define the desired depth for the corneal bed. Once the ideal is determined, he said, the surgeon can guide the surgical laser in the ablation in the anterior surface of the patient’s cornea to produce the desired corneal bed depth.

In a preliminary study of the technique, 15 eyes underwent the procedure. In all 15 cases a smooth stromal bed was attained, with an average thickness of 130 µ.

Dr. Carriazo described some of the advantages of the new procedure: “There’s no endothelial rejection, fewer complications, less risk of future keratoplasty, faster recovery, and the donor cornea does not need to be fresh and does not need to contain a high number of active endothelial cells,” he said.