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Microkeratome-Assisted Superficial Anterior Lamellar Keratoplasty for Anterior Stromal Corneal Opacities After Penetrating Keratoplasty

Patel, Amit K FRCOphth; Scorcia, Vincenzo MD; Kadyan, Anju MS, FRCS(Ed); Lapenna, Lucia MD; Ponzin, Diego MD; Busin, Massimo MD

doi: 10.1097/ICO.0b013e31820c9fd1

Purpose: To describe the surgical technique and report the outcomes of patients treated with microkeratome-assisted superficial anterior lamellar keratoplasty for anterior stromal corneal opacities developing after penetrating keratoplasty (PK).

Methods: All patients with post-penetrating keratoplasty anterior stromal opacities treated with microkeratome-assisted superficial anterior lamellar keratoplasty between July 2005 and June 2007 were reviewed. A 130-μm superficial keratectomy was performed, followed by the placement of an appropriately sized donor graft, which was secured with overlay sutures. Refraction, corneal topography, and uncorrected and best-corrected visual acuities (UCVA, BCVA, respectively) were noted at each examination.

Results: Nine eyes of 8 consecutive patients were identified. Causes of anterior stromal opacities included dystrophy recurrence (n = 3), post–photorefractive keratectomy haze (n = 2), and scarring after stromal melt (n = 4). BCVA improved in all 9 eyes at final follow-up, and 7 of 9 eyes achieved ≥20/40 within the first month. Average follow-up period was 28 ± 3.9 months. Refractive astigmatism also improved by an average of 0.7 diopters.

Conclusions: Superficial anterior lamellar keratoplasty is a viable and effective alternative to repeat PK in treating anterior stromal scars. It avoids open-globe surgery and exposure to endothelial rejection associated with repeat PK, and visual rehabilitation is considerably quicker.

From the *Department of Ophthalmology, Villa Serena Hospital, Forli, Italy; †Fondazione Banca degli Occhi del Veneto, Venice, Italy; ‡Department of Ophthalmology, University of Magna Graecia, Catanzaro, Italy; and §Birmingham and Midland Eye Centre, Birmingham, United Kingdom.

Received for publication November 10, 2009; revision received December 5, 2010; accepted December 12, 2010.

A. Patel received funding from the Pfizer (United Kingdom) Ophthalmic Fellowship Award.

M. Busin has received reimbursement of travel expenses and royalties from Moria (Antony, France).

Presented in part at the American Academy of Ophthalmology Annual Meeting, 2007, New Orleans, LA.

None of the other authors have any financial/conflicting interests to disclose.

The sponsor and funding organization had no role in the design or conduct of this research.

Reprints: Massimo Busin, Department of Ophthalmology, Villa Serena Hospital, Via Camaldolino, 47100 Forli, Italy (e-mail:

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.