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Lamellar Keratoplasty - Innovative Technology
Messmer E. M.,
Ludwig-Maximilians-Universität, Klinikum Innenstadt, Augenklinik (München)
It is well recognized that lamellar keratoplasties have distinct advantages over penetrating keratoplasty: fewer intraocular complications, no risk of endothelial rejection, no need for long-term immunosuppression and superior wound strength. Moreover, donor corneas with low endothelial cell counts can be used for transplantation. Lamellar keratoplasty, however, has not been popular because of technical difficulties and for optical reasons (interlamellar opacification, irregular astigmatism). New techniques such as deep (anterior) lamellar keratoplasty, microtom-assisted posterior keratoplasty, endokeratoplasty and transplantation of Descemet's membrane carrying autologous donor endothelium open up new surgical avenues. Controlled clinical studies are necessary to show whether these refined surgical lamellar techniques will represent an alternative to penetrating keratoplasty in selected cases in the future.