The purpose of this study was to evaluate the effectiveness of. Outcomes from a modified microkeratomeassisted lamellar. Repeat keratoplasty for failed therapeutic keratoplasty for. Lamellar keratoplasty or penetrating keratoplasty were performed for all cases. Lamellar keratoplasty an overview sciencedirect topics. The second operation is usually a simple lamellar keratoplasty. Therapeutic deep lamellar keratoplasty for corneal. Otherwise, penetrating keratoplasty would be performed. Lamellar keratoplasty lkp is an alternative surgical procedure that requires removal of only the. Deep anterior lamellar keratoplasty dalk, which involves the removal of anterior diseased cornea while leaving. Deep anterior lamellar keratoplasty american academy of. On day 5 after surgery, small whitish infiltrates developed in the corneal interface.
Pdf lamellar keratoplasty lk has revolutionized corneal graft. These include anterior lamellar keratoplasty alk techniques that aim to selectively replace diseased corneal stroma and endothelial. This patient first presented as a referral from an. Newer types of transplants, such as endothelial keratoplasty and anterior lamellar keratoplasty, selectively replace only diseased layers of the cornea and leave healthy areas intact.
A clear advantage of this form of lamellar keratoplasty over penetrating keratoplasty is that it replaces only the diseased. The purpose of this study was to evaluate the effectiveness of this treatment. Posterior lamellar keratoplastycomparison of deep lamellar. Deep lamellar endothelial keratoplasty dlek for fuchs. Lamellar keratoplasty article about lamellar keratoplasty. Deep lamellar keratoplasty in corneal dermoid eye nature. Mark terry modified by small incision 5mm rename the procedure. Keratoplasty an operation involving corneal grafting. Surgical treatment of deep corneal stromal abscess and hypopyon with posterior lamellar keratoplasty plk. Both treatments gave similar visual improvement, but the eye treated with ptk showed recurrence and postoperative haze. A 39yearold male patient underwent uncomplicated deep anterior lamellar keratoplasty due to keratoconus. Listing a study does not mean it has been evaluated by the u. Penetrating keratoplasty cornea research foundation of america.
Posterior lamellar keratoplasty or endothelial keratoplasty ek attempting to replace endothelial pathology, the rst posterior lamellar keratoplasty plk procedure was described by barraquer in. Automated lamellar keratoplasty for the correction of hyperopia guy m. Penetrating keratoplasty pk has been considered as the definitive procedure for the treatment of keratoconus over the past few decades 1, 2. May 12, 2006 deep lamellar keratoplasty dlk may be an alternative option to pk in such eyes owing to its potential for a lower incidence of rejection. These targeted techniques provide faster healing, require fewer activity restrictions, and reduce the risk of later injury to the eye. Dalk surgery can be done with a manual or hand dissection of donor tissue or by using air to detach the inner layer of. Keratoplasty has developed rapidly in the past 10 years and penetrating keratoplasty pk, a procedure consisting of fullthickness replacement of the cornea, has been the dominant procedure for more than half a century. Epithelial ingrowth following lamellar corneal procedures occurs in a diffuse pattern across the ocular structures and through the potential space of the lamellar interface as observed in laserassisted in situ keratomileusis, descemetstripping endothelial keratoplasty, or anterior lamellar keratoplasty.
When the entire cornea is replaced it is known as penetrating keratoplasty and when only part of the cornea is replaced it is known as lamellar keratoplasty. A cohort of 20 consecutive pks, for keratoconus, was compared with. Lamellar surgery is indicated if the pathlogy of the cornea is limited to specific layers that can be removed and replaced with clear, donor tissue. The concept of lamellar keratoplasty lk is not new. Lamellar keratoplasty lkp is an alternative surgical procedure that requires removal of only the damaged or diseased epithelium and stroma, leaving the endothelium intact, in cases where only the more superficial layers are damaged.
Lamellar keratoplasty for the treatment of feline corneal. To report the ratio of repeattoinitial keratoplasty among patients who had underwent therapeutic keratoplasty for microbial keratitis in southern china and to investigate the characteristics and risk factors of repeat keratoplasty. Penetrating keratoplasty, a procedure consisting of fullthickness replacement of the cornea, has been the dominant procedure for more than half a century, and successfully caters to most causes of corneal blindness. Lamellar and penetrating keratoplasty,, lamellar and penetrating keratoplasties are interventions in which total or partial transplantation of the corneal tissue is effectuated for the treatment of various diseases of the cornea that considerably decrease visual acuity. Comparative cohort study of the outcomes of deep lamellar. Penetrating and lamellar keratoplasty jessica chow terry kim penetrating keratoplasty penetrating keratoplasty pk is one of the most common forms of tissue transplantation currently performed.
Best vision is o btained with a type of alk known as deep anterior lamellar keratoplasty dalk, in which the surgeon only leaves behind 5% or less of your original corneal thickness and replaces the rest with donor tissue. Dlk is believed to be an effective treatment in eyes in which endothelial cell function had been preserved, and in which there was no epithelial or stromal oedema. Lamellar keratoplasty partialthickness grafting anterior or posterior lamellar 3. The lamellar graft is removed from the donor eye with an electrokeratotome or a martinez corneal dissector. Lamellar keratoplasty lk targets partial or lamellar replacement of diseased corneal tissue. The diagnosis of fungal keratitis was made when the culture medium of the graft grew candida after the surgical intervention.
There are numerous distinct methods of keratoplasty. Penetrating keratoplasty cornea research foundation of. Following a superficial keratectomy, lamellar corneal allografts feline corneal tissue or heterografts canine corneal tissue which had been preserved at 20 c were placed in the recipient cornea. The advantages of alk include reducing the risk of endothelial graft rejection, retaining structural integrity, and reducing potential intraoperative complications associated with open sky procedures 1. It has nudged aside its predecessor, descemet stripping automated endothelial keratoplasty dsaek, just as dsaek displaced its own forerunner, deep lamellar. However, it can also be one of the most challenging and. Descemet membrane endothelial keratoplasty dmek, the newest and most advanced form of endothelial transplantation, represents the culmination of the evolution of keratoplasty techniques.
Azar posterior lamellar endothelial keratoplasty refers to the removal of the diseased posterior corneal layers and their replacement by partialthickness donor tissue. Automated lamellar keratoplasty for the correction of. A fellow eye, comparative retrospective case series. Deep lamellar keratoplasty dlk may be an alternative option to pk in such eyes owing to its potential for a lower incidence of rejection. Deep lamellar endothelial keratoplasty dlek dlek is a variation in which only the endothelium is replaced. Deep anterior lamellar keratoplasty dalk full text. To compare the outcomes and complications of deep lamellar keratoplasty dlk and penetrating keratoplasty pk for keratoconus. Gerritt melles et al first described this technique involved large limbal incision and deep manual lamellar corneal dissection. Technique the area to be removed is outlined with a trephine set at 0. Deep anterior lk dalk has eliminated risk of failure due to.
However, manual dissection of the recipient bed and donor tissue potentially heals with interface scaring or haze that reduces the patients quality. Keratoplasty definition of keratoplasty by the free dictionary. Lamellar keratoplasty definition of lamellar keratoplasty. Deep anterior lamellar keratoplasty dalk dalk the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. However, newer forms of lamellar keratoplasty techniques have emerged in the last decade or so revolving around the concept of targeted replacement of diseased corneal layers. Feb 27, 2015 keratoplastycorneal grafting corneal transplantation definition. Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue the graft. Deep lamellar keratoplasty with complete removal of. Deep lamellar endothelial keratoplasty article about. Corneal transplantation or keratoplasty has developed rapidly in the past 10 years. Deep anterior lamellar keratoplasty dalk is a surgical procedure for removing the corneal stroma down to descemets membrane. Lamellar keratoplasty lk has revolutionized corneal graft surgery in several. Keratoconus, deep anterior lamellar keratoplasty, penetrating keratoplasty, corneal transplant, rejection. Anterior lamellar keratoplasty alk replaces a scarirregularity in the front of the cornea, with a partial thickness tissue, assuming the posterior cornea is normal.
A lamellar keratoplasty was used to treat corneal sequestrum in four persian cats six eyes. This article is from september 2007 and may contain outdated material. It is an operation in which the patients diseased cornea is replaced by the donors healthy clear cornea. Pdf lamellar keratoplasty lk has revolutionized corneal graft surgery in several ways. Repeat keratoplasty for failed therapeutic keratoplasty.
Keratoplasty is a broad term that includes all surgery proceedings executed on the cornea. We report a 1year intraindividual comparison of the functional and morphological outcomes of a patient with tbcd, who underwent deep anterior lamellar keratoplasty dalk in the left eye le and ptk in the right eye re. A free powerpoint ppt presentation displayed as a flash slide show on. A slightly larger graft is harvested by superficial keratectomyon the same cornea or contralateral cornea. Keratoplasty corneal grafting corneal transplantation definition. Newer trends in lamellar keratoplasty last decade has seen a renewed interest in lamellar keratoplasty with several modifications to improve visual outcome. Corneal dermoids are a rare cause of corneal opacification consisting of abnormal mesoblastic tissue covered by the. However, it can be complicated by allograft endothelial rejection with subsequent risk of graft failure. Aimsbackground deep lamellar keratoplasty dlk was performed to restore visual acuity in 120 eyes with corneal stromal opacification. Deep anterior lamellar keratoplasty dalk dalk is a partialthickness cornea transplant procedure that involves selective transplantation of the corneal stroma, leaving the native descemet membrane and endothelium in place. Current techniques of lamellar keratoplasty for keratoconus. The adoption by specialist surgeons of newer forms of lamellar. The records of 14 patients 28 eyes who underwent dlek in one eye and dsaek surgery in. It can be an extremely successful procedure, with dramatic visual improvement for the patient.
Cystic epithelial ingrowth in a case of deep anterior. Definition the replacement of diseased cornea with autologus or heterologus cornea is called as keratoplasty. Descemet stripping endothelial keratoplasty dsek dsek has gained widespread acceptance. Keratoplastycorneal grafting corneal transplantation definition. Melles, md, phd d escemet membrane endothelial keratoplasty dmek, the newest and most advanced form of endothelial transplantation, represents the culmination of the evolution of kerato. Posterior lamellar endothelial keratoplasty ento key. We should distinguish two major types of the cornea surgery. Mar 24, 2016 the procedure is longer than penetrating keratoplasty but is associated with a reduced risk of rejection. Posterior lamellar endothelial keratoplasty nicoletta fynnthompson dimitri t. To improve visual and refractive outcomes, microkeratomeassisted lamellar keratoplasty for the treatment of keratoconus exchange of a 9. In most of the cases the donor cornea is taken from a deceased person. Surgical techniques varied according to the size, severity, and stromal depth of corneal lesions. To evaluate patients perspectives on endothelial keratoplasty and to compare the outcomes of deep lamellar endothelial keratoplasty dlek and descemet stripping automated endothelial keratoplasty dsaek, performed in the same patients. Tuck in lamellar keratoplasty tilk for corneal ectasias.
It is most useful for the treatment of corneal disease in the setting of a normally functioning endothelium. It is performed when there are persistent opacities leukomas of the cornea that cause a severe decrease in vision, in order to partially or completely. Oct 07, 20 lamellar keratoplasty lk targets partial or lamellar replacement of diseased corneal tissue. Endothelial keratoplasty ek purpose to remove the diseased recipient endothelium and replace with healthy donor corneal endothelium. Recent evidence reported an increasing trend in the incidence of fungal infection after endothelial keratoplasty compared to penetrating keratoplasty pk, although neither observation reached statistical significance. Refractive surgery radial keratotomy photorefractive keratectomy prk laser insitu keratomileusis.
Pdf therapeutic deep lamellar keratoplasty for corneal. In, terry and ousley introduced endothelial keratoplasty ek. Pdf the concept of lamellar keratoplasty lk is not new. Lamellar keratoplasty was chosen if lesion appeared not to breach the descemet membrane. Lamellar keratoplasty and deep lamellar keratoplasty are effective procedures to remove scarred corneal opacity. Lamellar keratoplasty moderator dr sundeep presenter dr akshay nayak 2. These include anterior lamellar keratoplasty alk techniques that aim to selectively replace diseased corneal stroma and endothelial keratoplasty techniques aiming. Keratoplasty definition of keratoplasty by the free. Automated lamellar therapeutic keratoplasty altk is a newly developed surgical procedure based on microkeratomeassisted keratoplasty that provides a smooth and sharp corneal stromal excision. This involves a partial thickness of the cornea that is transplanted to selectively replace only the diseased portion leaving the rest of the healthy cornea of the patient undisturbed. Deep anterior lamellar keratoplasty and phototherapeutic. Therapeutic deep lamellar keratoplasty for corneal perforations article pdf available in eye 219.
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