Deep lamellar keratoplasty with lyophilised tissue in the management of keratoconus

• Published in: British journal of ophthalmology Vol. 85; no. 7; pp. 788 - 791
• Main Authors: Coombes, Andrew G A, Kirwan, James F, Rostron, Chad K
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01-07-2001; BMJ; BMJ Publishing Group LTD
• Subjects: Adolescent; Adult; Anterior Chamber - pathology; Biological and medical sciences; Care and treatment; Child; Cornea; Descemet Membrane - injuries; Eye; Follow-Up Studies; Humans; Keratoconus; Keratoconus - physiopathology; Keratoconus - surgery; Keratoplasty, Penetrating - methods; lamellar keratoplasty; lyophilised tissue; Medical sciences; Middle Aged; Physiological aspects; Postoperative Complications; Refractometry; Retrospective Studies; Scientific Correspondence; Statistics, Nonparametric; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Visual Acuity; United Kingdom; Human; Cornea; Lamellar graft; Keratopathy; Lyophilized graft; Air injection; Eye; Eye disease; Treatment; Keratoconus; Keratoplasty; Surgery; Technique
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjo.85.7.788

AIMS Data are presented on the use of deep lamellar keratoplasty (DLK) using lyophilised donor corneal tissue, in the management of patients with keratoconus (KC). METHOD The results of DLK on 44 eyes (42 patients) are reported. The mean patient age was 29.8 years (range 10–56). Mean follow up was 25 months (range 6–100). In seven patients with mental handicap or severe mental illness, the collection of acuity and refractive data was limited. RESULTS Perforation of Descemet's membrane (DM) occurred in nine cases (20%). A double anterior chamber formed in five cases, which resolved spontaneously in three patients. Persistent epithelial defects occurred in two cases, one of which necessitated replacement of the graft. The median postoperative uncorrected visual acuity was 6/36. The median corrected postoperative acuity was 6/9. Those with more than 1 year of follow up (n=25) had a significantly better acuity (p=0.015). This group achieved 6/12 or better in 80% (n=20) and 6/6 or better in 40% (n=10). The mean postoperative spherical error was +0.28 (SD 3.49) dioptres (D). The mean refractive cylinder was 3.85 (1.87) D. CONCLUSION This detailed retrospective study of DLK for the treatment of patients with KC, with an average follow up of 2 years, highlights the advantages and disadvantages of this technique.