Deep Lamellar Keratoplasty with an Excimer Laser and the Guided Trephine System (GTS)
Krumeich J. H., Schöner P., Knuelle A., Theilen H.
Klinik Krumeich, Bochum
Purpose: Visual acuities in deep lamellar keratoplasties may be 20/25 or better only if Decemets membrane is cleared. Techniques available all include the risk of perforation of Descemets because the posterior layers of the Parenchyma must be separated from Descemets by hand. This study is to clarify if hand cut posterior layers may yield better results by Excimer laser smoothing.
Method: 12 eyes, the visual acuity of which was below 20/30 eight months postoperatively after deep lamellar keratoplasty and in which the posterior layers were at least 100 m thick were re-trephined. Both sides of the interface, the posterior layers of the recipient and the denuded Descemet of the donor button were treated with a phototherapeutic keratectomy with a tissue off-take between 20 and 40 m.
Results: Visual acuity increased in 10 of the 12 cases to 20/25 or better within an interval of 4-6 months. One case remained unchanged, one case worsened to 20/50 as a result of a fine leakage caused by the Excimer.
Conclusions: Excimer Laser smoothing of hand resected posterior layers in deep lamellar keratoplasties can be performed as primary operation or in case visual acuity does not match retinal resolution postoperatively. In all ten cases who primarily did not reach 20/30 the secondary intervention led to normal visual acuity in a high percentage (80%
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