Automated lamellar keratoplasty for the correction of. It is most useful for the treatment of corneal disease in the setting of a normally functioning endothelium. Keratoplasty definition of keratoplasty by the free dictionary. Keratoplasty definition of keratoplasty by the free. These include anterior lamellar keratoplasty alk techniques that aim to selectively replace diseased corneal stroma and endothelial keratoplasty techniques aiming. 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. Cystic epithelial ingrowth in a case of deep anterior. There are numerous distinct methods of keratoplasty. Lamellar keratoplasty and deep lamellar keratoplasty are effective procedures to remove scarred corneal opacity.
Corneal transplantation or keratoplasty has developed rapidly in the past 10 years. Large solid dermoids require deep keratoplasty with the use of either fresh lamellar or preserved corneal donor tissue. This article is from september 2007 and may contain outdated material. Pdf the concept of lamellar keratoplasty lk is not new. Descemet stripping endothelial keratoplasty dsek dsek has gained widespread acceptance.
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. Pdf therapeutic deep lamellar keratoplasty for corneal. 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. Deep lamellar endothelial keratoplasty dlek dlek is a variation in which only the endothelium is replaced. In, terry and ousley introduced endothelial keratoplasty ek.
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. 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. It has nudged aside its predecessor, descemet stripping automated endothelial keratoplasty dsaek, just as dsaek displaced its own forerunner, deep lamellar. Deep lamellar keratoplasty with complete removal of. This patient first presented as a referral from an. Deep anterior lamellar keratoplasty and phototherapeutic. 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. Endothelial keratoplasty ek purpose to remove the diseased recipient endothelium and replace with healthy donor corneal endothelium. Definition the replacement of diseased cornea with autologus or heterologus cornea is called as keratoplasty. Lamellar keratoplasty lk targets partial or lamellar replacement of diseased corneal tissue. It is an operation in which the patients diseased cornea is replaced by the donors healthy clear cornea. Posterior lamellar keratoplastycomparison of deep lamellar. Keratoplastycorneal grafting corneal transplantation definition. Lamellar keratoplasty for the treatment of feline corneal. Oct 07, 20 lamellar keratoplasty lk targets partial or lamellar replacement of diseased corneal tissue. The purpose of this study was to evaluate the effectiveness of this treatment. A slightly larger graft is harvested by superficial keratectomyon the same cornea or contralateral cornea. Lamellar keratoplasty lk has revolutionized corneal graft surgery in several. Listing a study does not mean it has been evaluated by the u. Tuck in lamellar keratoplasty tilk for corneal ectasias.
To improve visual and refractive outcomes, microkeratomeassisted lamellar keratoplasty for the treatment of keratoconus exchange of a 9. Pdf lamellar keratoplasty lk has revolutionized corneal graft surgery in several ways. 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. Comparative cohort study of the outcomes of deep lamellar. Gerritt melles et al first described this technique involved large limbal incision and deep manual lamellar corneal dissection. 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. A lamellar keratoplasty was used to treat corneal sequestrum in four persian cats six eyes. A clear advantage of this form of lamellar keratoplasty over penetrating keratoplasty is that it replaces only the diseased. Lamellar keratoplasty an overview sciencedirect topics. These include anterior lamellar keratoplasty alk techniques that aim to selectively replace diseased corneal stroma and endothelial. The concept of lamellar keratoplasty lk is not new.
Automated lamellar therapeutic keratoplasty altk is a newly developed surgical procedure based on microkeratomeassisted keratoplasty that provides a smooth and sharp corneal stromal excision. Deep anterior lamellar keratoplasty dalk dalk the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Therapeutic deep lamellar keratoplasty for corneal perforations article pdf available in eye 219. Mar 24, 2016 the procedure is longer than penetrating keratoplasty but is associated with a reduced risk of rejection. 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. Lamellar keratoplasty partialthickness grafting anterior or posterior lamellar 3. Keratoconus, deep anterior lamellar keratoplasty, penetrating keratoplasty, corneal transplant, rejection. The purpose of this study was to evaluate the effectiveness of. However, it can be complicated by allograft endothelial rejection with subsequent risk of graft failure. Both treatments gave similar visual improvement, but the eye treated with ptk showed recurrence and postoperative haze.
Lamellar keratoplasty moderator dr sundeep presenter dr akshay nayak 2. 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. Refractive surgery radial keratotomy photorefractive keratectomy prk laser insitu keratomileusis. Lamellar keratoplasty article about lamellar keratoplasty. Lamellar keratoplasty definition of lamellar keratoplasty. Deep lamellar endothelial keratoplasty article about. The lamellar graft is removed from the donor eye with an electrokeratotome or a martinez corneal dissector.
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. Posterior lamellar endothelial keratoplasty ento key. 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. Automated lamellar keratoplasty for the correction of hyperopia guy m. 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. Repeat keratoplasty for failed therapeutic keratoplasty for. 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. Deep lamellar endothelial keratoplasty dlek for fuchs. These targeted techniques provide faster healing, require fewer activity restrictions, and reduce the risk of later injury to the eye. 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. Dalk surgery can be done with a manual or hand dissection of donor tissue or by using air to detach the inner layer of.
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. Newer trends in lamellar keratoplasty last decade has seen a renewed interest in lamellar keratoplasty with several modifications to improve visual outcome. The records of 14 patients 28 eyes who underwent dlek in one eye and dsaek surgery in. Penetrating keratoplasty cornea research foundation of. The adoption by specialist surgeons of newer forms of lamellar. Penetrating keratoplasty pk has been considered as the definitive procedure for the treatment of keratoconus over the past few decades 1, 2. Repeat keratoplasty for failed therapeutic keratoplasty. Azar posterior lamellar endothelial keratoplasty refers to the removal of the diseased posterior corneal layers and their replacement by partialthickness donor tissue. 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 was chosen if lesion appeared not to breach the descemet membrane. Feb 27, 2015 keratoplastycorneal grafting corneal transplantation definition. However, manual dissection of the recipient bed and donor tissue potentially heals with interface scaring or haze that reduces the patients quality. 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. Aimsbackground deep lamellar keratoplasty dlk was performed to restore visual acuity in 120 eyes with corneal stromal opacification.
In most of the cases the donor cornea is taken from a deceased person. Deep anterior lk dalk has eliminated risk of failure due to. 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. The diagnosis of fungal keratitis was made when the culture medium of the graft grew candida after the surgical intervention. Corneal dermoids are a rare cause of corneal opacification consisting of abnormal mesoblastic tissue covered by the. 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. 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. 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. Posterior lamellar endothelial keratoplasty nicoletta fynnthompson dimitri t. Therapeutic deep lamellar keratoplasty for corneal. Deep anterior lamellar keratoplasty dalk full text.
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. Outcomes from a modified microkeratomeassisted lamellar. Penetrating keratoplasty cornea research foundation of america. The second operation is usually a simple lamellar keratoplasty. Surgical treatment of deep corneal stromal abscess and hypopyon with posterior lamellar keratoplasty plk. A fellow eye, comparative retrospective case series.
Current techniques of lamellar keratoplasty for keratoconus. Deep anterior lamellar keratoplasty dalk, which involves the removal of anterior diseased cornea while leaving. Pdf lamellar keratoplasty lk has revolutionized corneal graft. Deep lamellar keratoplasty in corneal dermoid eye nature. Technique the area to be removed is outlined with a trephine set at 0. We should distinguish two major types of the cornea surgery. A 39yearold male patient underwent uncomplicated deep anterior lamellar keratoplasty due to keratoconus. Deep lamellar keratoplasty dlk may be an alternative option to pk in such eyes owing to its potential for a lower incidence of rejection. A free powerpoint ppt presentation displayed as a flash slide show on. Mark terry modified by small incision 5mm rename the procedure. It can be an extremely successful procedure, with dramatic visual improvement for the patient. Deep anterior lamellar keratoplasty dalk is a surgical procedure for removing the corneal stroma down to descemets membrane.
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. On day 5 after surgery, small whitish infiltrates developed in the corneal interface. Posterior lamellar keratoplasty or endothelial keratoplasty ek attempting to replace endothelial pathology, the rst posterior lamellar keratoplasty plk procedure was described by barraquer in. 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. Surgical techniques varied according to the size, severity, and stromal depth of corneal lesions.
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