Intrastromal ‘sliding’ technique effectively addresses astigmatism following anterior keratoplasty

BASSANO DEL GRAPPA, Italy — A manual technique combining arcuate incisions and horizontal separation within stromal layers can effectively address astigmatism following anterior corneal transplantation, according to one surgeon.

This technique, according to Massimo Camellin, MD, can be applied to address astigmatic depression areas, where the donor cornea has sunk below the recipient level.

Massimo Camellin

“A vertical incision is performed in the paralimbal areas of the recipient cornea, using a diamond knife, down to no more than 70% of corneal pachymetry. Using a disc knife, horizontal separation is carried out at 90° towards the center, sparing a central approximately 3-mm optical zone,” Camellin said at an ophthalmology meeting at the San Bassiano Hospital here.

The technique aims at relaxing the stromal tissue in depth by producing an intrastromal sliding effect on tissue layers. The endothelial folds that might be created by lamellar keratoplasty and cause visual disturbances and astigmatic refractive error are smoothened.

Camellin recommended that his technique, named “arcuate incisions with intrastromal sliding,” should not be used when the astigmatism is produced by graft elevation rather than depression, as it would lead to bulging and increased coma.

This procedure has an immediate positive effect on the astigmatic error and does not jeopardize secondary graft procedures when needed.

“Although we perform the incision on the recipient, there should be no concern because the paralimbal incision heals quickly and regains perfect cohesion. Removal and replacement of the lamellar graft, if needed, can be performed without any problem,” Camellin said.

Disclosure: Camellin has no relevant financial disclosures.