Recent advances in Cornea transplantation enable us to replace the specific part of the cornea that is diseased, when the disease has not extended to the all the layers of the cornea. This is known as a Lamellar (partial) Keratoplasty. This improves our ability to treat many corneal diseases more effectively. This has led to better visual outcomes, lower graft rejection risk and longer graft survival following corneal transplantation.
Anterior lamellar keratoplasty
Anterior lamellar keratoplasty is performed for patients with diseases involving the upper portion of the cornea such as 1) anterior scars, 2) anterior dystrophies, 3) keratoconus and 4) infectious keratitis. The advantages are that it is essentially an extraocular procedure, which results in a stronger wound, produces less astigmatism, and has a significantly lower risk of allograft rejection and graft failure as compared to conventional penetrating keratoplasty.
Posterior lamellar keratoplasty / Endothelial keratoplasty
In cornea diseases where the innermost layer of the cornea (endothelium) is affected, such as in certain degenerative diseases like Fuch’s endothelial dystrophy or bullous keratopathy, just the innermost layer of the cornea may be replaced. The surgery can be performed through smaller incisions and the cornea graft can be secured in place without stitches. The new method is known as Descemet’s stripping automated endothelial keratoplasty (DSAEK).
The advantages are:
1. The donor graft is attached without sutures, and so there are suture related problems.
2. Patients can have a faster visual recovery
3. The vision is better
4. Less irregularity and astigmatism.
5. Eye is more comfortable
6. Greater wound strength
The use of semi-automated microkeratomes have further enhanced our ability to create a smoother dissection plane, reduce interface irregularity and improve the visual outcome.