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Central Lamellar Keratoplasty for Optical Indications

Soong, H. Kaz M.D.; Katz, Douglas G. M.D.; Farjo, Ayad A. M.D.; Sugar, Alan M.D.; Meyer, Roger F. M.D.

Article: ABSTRACT Only

Purpose This study aims to evaluate the results of lamellar keratoplasty (LKP) for optical (nontectonic) indications over the past 19 years at our institution, noting the advantages and pitfalls of the procedure.

Methods The study is a retrospective review of 52 central LKPs in 37 patients. Snellen visual acuity, preoperative clinical indications, and postoperative status of the cornea (donor graft, graft—host interface, and recipient cornea) were assessed.

Results Postoperative follow-up ranged from 3 months to 18 years (median, 3 years). In descending order of frequency, corneal dystrophies, aniridic keratopathy, corneal scars, and keratoconus were the most common indications for surgery. After surgery, 38% of the eyes were able to achieve 20/50 or better visual acuity. The two most common causes of poor visual acuity were (1) opacification and/or blood vessel growth in the graft—host interface or on the graft surface and (2) high astigmatism. Persistent epithelial defects occurred in 21% of the eyes after LKP.

Conclusion Although LKP provides a safer alternative to penetrating keratoplasty, it is limited by vision-reducing graft—host interface problems, astigmatism, and difficult surgical technique. We postulate that the current results of LKP may be improved by (1) removing as much recipient corneal stroma as possible (e.g., dissecting down to Descemet's membrane) or, alternatively, using an automated microkeratome and (2) raising the currently used qualitative eyebank standards for accepting LKP donor tissue.

From the W.K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.

Address correspondence and reprint requests to Dr. H.K. Soong, W.K. Kellogg Eye Center, 1000 Wall Street, Ann Arbor, MI 48105, U.S.A. E-mail:

Submitted September 22, 1998. Revision received November 20, 1998. Accepted November 25, 1998.

© 1999 Lippincott Williams & Wilkins, Inc.