Jh. Krumeich et al., DEEP LAMELLAR KERATOPLASTY WITH THE GUIDED TREPHINE SYSTEM FOR TRANSPLANTING FULL-THICKNESS DONOR TISSUE, Der Ophthalmologe, 95(11), 1998, pp. 748-754
Background: Despite the fact that deep lamellar keratoplasty (DLKP) is
less invasive than to penetrating keratoplasty (PKP), this procedure
is rarely performed. We therefore investigated whether or not the DLKP
technique we employed can achieve stable improvement of visual acuity
. Materials and methods: Thirty-three eyes underwent TLKP for treatmen
t of superficial corneal pathology. The donor tissue transplanted was
suitable for PKP. The donor lenticule was obtained on the artificial c
hamber of the guided trephine system (GTS). The recipient cornea was t
rephined with the same trephine to a depth of 680 mu m. Manual dissect
ion was performed with a bevel-up blade. The donor lenticule with the
endothelium peeled off was then sutured in with a 10 x 0 nylon double-
running antitorque suture. Cortisone-antibiotic eye drops were adminis
tered postoperatively. Results:Throughout the series no complications
occurred. The mean best corrected visual acuity (BSCVA) over glasses w
as 0.29 ( +/- 0.21) preoperatively, 0.1 (+/- 0.11) at 1 week, 0.33 (+/
- 0.14) at 1 month, 0.5 ( +/- 0.13) at 6 months, 0.61 ( +/- 0.16) at 1
year and 0.63 ( +/- 0.15) at 2 years. Clinically, we observed two sub
populations. In the first group of 87 % of the cases, mean BSCVA was 0
.67 (+/- 0.07) at 6 months. The remaining cases (BSCVA less than or eq
ual to 0.25 at 6 months) achieved a mean BSCVA of only 0.2 ( +/- 0.04)
at 1 year. Mean corneal astigmatism measured 2.93 D (+/- 1.62) preope
ratively, 2.69 D ( +/- 1.18) at 1 month, 2.09 D (+/- 1.07) at 1 year,
and 2.22 D (+/- 1.71) at 2 years. We did not observe any graft rejecti
on. C onclusion: The technique reported for DLKP provides excellent ma
tching of donor lenticule and recipient bed. Separation of donor and r
ecipient stroma prevents interface healing. DLKP appears to be a safe
procedure for the surgical treatment of superficial corneal pathology
and may offer a clinically applicable alternative to PKP.