Microkeratome-Assisted Superficial Anterior Lamellar Keratoplasty: Prospective Interventional Case Series
To report the indications, visual and refractive outcomes of patients following microkeratome assisted superficial anterior lamellar keratoplasty (SALK).
Prospective interventional case series. Nine eyes of nine patients with anterior corneal pathology underwent pre operative anterior segment optical coherence tomography (AS- OCT) followed by microkeratome assisted SALK. Depth of pathology, thickness of donor lamellar disc used, pre and postoperative uncorrected distance visual acuities (UDVA) and corrected distance visual acuities (CDVA); and complications were evaluated. Indications for surgery were anterior stromal scarring secondary to herpetic keratitis (n =4); contact lens induced infectious keratitis (n = 2), and anterior stromal dystrophies (n= 3). The donor lamellar disc was secured with a combination of sutures and fibrin glue.
There were no intraoperative complications. Mean age of the cohort was 49 ± 17 years (range 29 – 80). Average depth of pathology on AS-OCT was 165 ± 39 microns (range 144 – 240 microns). Pre and post operative mean UDVA were 1.16 logMAR and 1.06 logMAR, respectively. Pre and post operative mean CDVA were 0.76 logMAR and 0.68 logMAR, respectively. In all cases except two, SALK was successful in totally removing the scar from the host cornea. One subject developed infectious interface keratitis in the postoperative period that required deep anterior lamellar keratoplasty.
AS – OCT is a useful device to assess the depth of anterior corneal pathologies. Microkeratome assisted SALK is a safe and effective technique to employ in the surgical management of anterior corneal pathologies.