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“Tuck In” Lamellar Keratoplasty for Tectonic Management of Postkeratoplasty Corneal Ectasia With Peripheral Corneal Involvement

Vajpayee, Rasik B MS, FRCS(Edin), FRANZCO; Jhanji, Vishal MD; Beltz, Jacqueline MBBS, FRANZCO; Moorthy, Sonia MBChB

doi: 10.1097/ICO.0b013e3181ead943
Clinical Science

Purpose: Evaluation of “tuck in” lamellar keratoplasty (TILK) for the surgical management of postkeratoplasty corneal ectasia with peripheral corneal involvement.

Methods: Four eyes of 3 patients with post-penetrating keratoplasty corneal ectasia and contact lens intolerance underwent TILK that included a central lamellar keratoplasty with intrastromal tucking of the peripheral flange, at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia. The main outcome measures analyzed were uncorrected visual acuity, best-corrected visual acuity, keratometry, and endothelial cell density.

Results: The original indication for surgery was keratoconus in all the cases. TILK was successfully performed in these patients. Mean follow-up period was 13 months (SD: 7.74) (range: 6-24 months). The preoperative best-corrected visual acuity improved from a mean value of 0.05 (SD: 0.05) to 0.34 (SD: 0.03) (P < 0.001). Mean keratometry decreased from 59.67 diopter (SD: 7.18) preoperatively to 43.50 diopter (SD: 2.23) postoperatively (P < 0.005). Mean endothelial cell loss after TILK was 5.93% (SD: 3.06) (P < 0.206). All grafts were clear at the last follow-up, and no cases of stromal or endothelial graft rejection were encountered.

Conclusions: TILK can be successfully performed for post-penetrating keratoplasty corneal ectasia with peripheral corneal thinning.

From the *Melbourne University Department of Ophthalmology, Centre for Eye Research Australia, University of Melbourne, Australia; †Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia; and ‡Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.

Received for publication March 7, 2010; revision received May 2, 2010; accepted May 15, 2010.

Accepted for presentation at the World Cornea Congress 2010 meeting, Boston.

Reprints: Rasik B. Vajpayee, Royal Victorian Eye and Ear Hospital, Centre for Eye Research Australia, University of Melbourne, 32, Gisborne St, East Melbourne, Victoria 3002, Australia (e-mail:

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