Vol.13
No. 1, October 2003
INDICATIONS
AND OUTCOME OF OPTICAL PARTIAL THICKNESS LAMELLAR KERATOPLASTY
Dr.
Jaspreet Sukhija , Dr. Jagjit S. Saini , Dr. Arun K. Jain ,
Dr. Vandana Saroha
INTRODUCTION
Lamellar
keratoplasty (LKP) consists of transplanting partial thickness
donor cornea, devoid of endothelium, descemet's membrane and
deep stroma on a recipient bed that has been dissected free of
overlying pathological anterior stroma. Compared with
penetrating keratoplasty (PKP), lamellar keratoplasty has
several advantages. Most complications associated with
open sky surgery are avoided, sutures can be removed earlier
and risk of wound dehiscence and allograft rejection is lower.
LKP can also be done for tectonic and therapeutic procedures.1-4
Aim:-
To study the indications and outcome of Lamellar Keratoplasty.
MATERIAL
AND METHODS
The
clinical records of 126 patients who underwent 138 optical
partial thickness lamellar keratoplasty procedures from
January 1978 to June 2001 were studied. Lamellar
keratoplasties done for peripheral corneal pathologies were
not included in the study as they were done mainly for
tectonic purposes. Clinic information was obtained
retrospectively from patient's cornea clinic files. Data
included indications for LKP, age, sex, laterality, graft
size, follow up, post-op visual acuity, complications during
the follow up period and the state of the graft at the last
follow up.
RESULTS
In
this retrospective study, records of 126 patients who had
undergone LKP's were reviewed. The mean age at the time
of keratoplasty was 52.91 years ( range 2-81 years).
There were 81 males ( M: F, 1.4:1). Seventy six surgeries were
performed on the right eye and 62 on the left eye.
Lamellar
keratoplasty was performed for optical purposes in all cases.
The most common indication was climatic droplet keratopathy (CDK)
in 62 (45%) eyes.
(
Table 1)
INDICATIONS
OF LAMELLAR KERATOPLASTY
|
Diagnosis
|
Eyes,
number
|
(%)
|
|
Climatic
droplet keratopathy
|
62
|
45
|
|
Infectious
keratitis scar
|
31
|
22.5
|
|
Band
Shaped keratopathy
|
6
|
4.3
|
|
Herpetic
Scars
|
6
|
4.3
|
|
Salzman
nodular degeneration
|
3
|
2.2
|
|
Lattice
corneal dystrophy
|
6
|
4.3
|
|
Macular
corneal dystrophy
|
3
|
2.2
|
|
Traumatic
corneal scars
|
3
|
2.2
|
|
Dermoid
|
3
|
2.2
|
|
Amyloid
|
1
|
0.7
|
|
Regraft
|
2
|
1.4
|
|
Unmentioned
|
12
|
8.7
|
Follow
up records were available for 130 eyes of 119 patients.
The duration of follow up ranged from one month to 174 months
( average 34.5 months). Seven eyes were recorded with
infiltrates post-operatively. Presumed graft rejection
was observed in 2 eyes. In 31 eyes, interface opacities
or residual host stromal opacities were present.
Non-healing epithelial defect was recorded in 2 eyes, which
healed following tarrsoraphy. Seventeen eyes
demonstrated sub optimal visual gain because of associated
cataract. Amblyopia was responsible for failure to gain
vision in 3 eyes post-operatively. Opacification of the
graft occurred in 9 eyes. One hundred and twenty one
eyes remained clear. Twenty-two patients (eyes) enjoyed
postoperative visual acuity of better than 6/12.
DISCUSSION
Lamellar
keratoplasty is usually performed for the removal of anterior
stromal opacities, which may or may not be associated
with corneal surface irregularities.5 It is
technically more difficult than PKP, but being an extra-ocular
procedure, there is little or no alteration of the
intra-ocular anatomy, less overall inflammation, and a
sturdier wound, as compared to PKP.5 Immune
graft rejection is rare. 5 These advantages
make LKP particularly suitable for non compliant patients at
high risk of ocular trauma. Donor tissue requirements
are less stringent for LKP than in PKP.5
In study involving 52 eyes of 37 patients. Soong et al5
reported that the main indication for optical LK were
corneal dystrophies (27%) followed by aniridic keratopathy
(19.2%), corneal scarring after infectious keratitis (15.4%),
keratoconus (13.5%) and dermoids (2%). In contrast, in
our study CDK and infectious keratitis scars were the two most
common indications for LKP (45% and 22.5% respectively).
In this part of the country hot climate, large agrarian
population and exposure to sunlight are responsible for the
high incidence of CDK and corneal ulcers.
LKP
is a relatively safe procedure with minimal vision threatening
complications. Most of the patients have a moderate
increase in visual acuity. This procedure utilizes less
than optical grade corneas, which has a dual advantage in a
country like India where the number of patients are a large
and eye donations are limited.
REFERENCES
-
Soong
HK, Farjo AA , Katz D et al. Lamellar corneal patch grafts
in the management of corneal melting. Cornea 2000;
19:126-134.
-
Karabatas
CH, Marsh GW, Cool AM et al. Different therapeutic
approaches and outcome in the treatment of pterygium.
Eur J Ophthalmol 1998;8:148-152
-
Richard
JM, Paton B, Gasset AR. A comparision of
penetrating keratoplasty and lamellar keratoplasty in
surgical management of keratoconus. Am J Ophthalmol 1978;
86:807-811.
-
Benson
WH, Goosey CB, Prager TC, Goosey JD.
Visual Improvement as a function of time after lamellar
keratoplasty for keratoconus. Am J Ophthalmol
1993; 116:207-211
-
Soong
HK, Katz DJ , Farjo AA, Sugar A, Meyer
RF. Central lamellar keratoplasty for optical indications.
Cornea 1999; 18:249-256
Department
Of Ophthalmology,
Post Graduate Institute of Medical Education and
Research, Chandigarh
