LIVE-EPIKERATOPHAKIA AND DEEP LAMELLAR KERATOPLASTY FOR STAGE-RELATEDTREATMENT OF KERATOCONUS

Background Perforating keratoplasty (PKP) for the treatment of keratoc onus is a temporary procedure that sacrifices the healthy recipient en dothelium. As an alternative to PKP we perform live-epikeratophakia (L -EPI) in keratoconus I-II and deep lamellar keratoplasty (DLKP) in ker atoconus II-III. Patients and Methods 20 patients with keratoconus wer e operated on either with L-EPI for keratoconus I-II (n = 10) or DLKP for keratoconus II-III (n = 10) respectively. In all cases, corneal ti ssue eligible for corneal transplantation was used. L-EPI: The corneal lenticule was prepared by means of the Barraquer-Krumeich-Swinger (BK S) set. The recipient cornea was trephined to a depth of 0.3 mm with t he Guided-Trephine-System (GTS). The incision was extended manually (i nner diameter 7.0 mm, outer diameter 9.0 mm). No keratectomy was perfo rmed. The lenticule was fixed with a 10 x 0 nylon double-running anti- torque suture (DRA). DLKP: The recipient cornea was trephined with the 8.0 mm GTS to a depth of 0.68 mm. A lamellar removal of the upper lay ers was performed by hand. After mechanical removal of the graft endot helium. the remaining full thickness donor cornea was sutured into the bed with a 10 x 0 nylon DRA suture. Results L-EPI: Within this series , there was no disturbance of the healing process. Spherical equivalen t and corneal astigmatism remained stable from the first month on. Vis ual acuity of 20/40 or better was obtained in 40% of the cases at 1 mo nth, 53% at 6 months, and 100% at 1 year and 2 years. We did not obser ve any late decline of VA. Two patients with kerato-conus borderline s tage II did not reach useful VA due to insufficiently reduced pre-exis ting irregular corneal astigmatism. These patients successfully underw ent DLKP at 8 and 10 months respectively. DLKP: Except for 1 case (neu rodermatitis), all lenticules remained stable with respect to refracti on and radii up to the longest fellow-up of 2 years. Starting from the first month on, refraction was stable. Visual acuity of 20/40 or bett er was reached in 33% of the cases at 1 month, in 56% at 6 months, and in 89% at 1 and 2 years. We did not administer systemic cyclosporine- A in either group. In the lamellar techniques presented, we did not ob serve any graft rejection. According to corneal topography, corneal as tigmatism, spherical equivalent, and keratometry we did not observe an y late re-onset of a progression of the cone. Conclusion In patients w ith keratoconus stage I to III, L-EPI or DLKP appeared to be very usef ul therapies. Both procedures seem to end progression of the disease a nd allow to preserve the healthy recipient endothelium. If unsuccessfu l, either procedure may be repeated. Neither procedure precludes possi bly later needed PKP.