Surgeon: Microkeratome-assisted keratoplasty an option for ectasia

PARIS — A modified keratoplasty technique that uses the same microkeratome to create the recipient corneal bed and donor corneal cap may be successful for cases of corneal ectasia, suggested one surgeon speaking here.

Lawrence Pe, MD, discussed the technique of microkeratome-assisted lamellar allograft keratoplasty (MALK) on 10 patients with iatrogenic or idiopathic corneal ectasia at the European Society of Cataract and Refractive Surgeons meeting.

With the eye under peribulbar anesthesia, a Moria LSK microkeratome was used to remove a 200 µm thick/9 mm diameter section from the recipient’s cornea, Dr. Pe said. A donor cap approximately 350 µm thick/8 mm in diameter was then created from a donor eye and sutured onto the recipient’s corneal bed.

“Having the graft 1 mm smaller than the recipient’s bed creates a mechanical effect on the bed when it is sutured in place,” Dr. Pe said.

After 6 months of follow-up, uncorrected visual acuity improved from a preoperative mean of 20/400 to a postoperative mean of 20/60. Mean best corrected visual acuity improved from 20/80 preop to 20/30 postop, Dr. Pe said.

Spherical equivalent also improved from a mean of –5.77 D preop to –2.93 D postop, Dr. Pe said.

Two cases developed some subepithelial haze, he said, but he attributed the haze to the age of the donor cornea at the time of transplant. In cases in which haze developed, corneas were older than 4 weeks, he said.