Fluid lamellar keratoplasty in keratoconus.

Abstract

The authors evaluated the efficacy of the modified technique of fluid deep lamellar keratoplasty in keratoconus. Noncomparative case series. Twenty-six eyes of 25 patients with moderate to advanced keratoconus were included. Fourteen males and 11 females with age range of 16 to 37 years. Deep lamellar keratoplasty aided by intrastromal injection of balanced salt solution to facilitate corneal dissection down to Descemet's membrane. Full-thickness graft devoid of endothelium and Descemet's membrane was then sutured in place. Spectacle-corrected visual acuity, slit-lamp biomicroscopy, corneal topography, and ocular tension. Two cases (8.4%) were converted to penetrating keratoplasty because of intraoperative perforation. Of the 24 successful cases, 19 eyes (79%) achieved >20/50 at 3 months and 21 (87.5%) achieved >20/40 at 6 months. Twenty-three eyes (95.8%) were 20/30 or better 1 year after suture removal. Only one eye (4.2%) had interface irregular astigmatism corrected by contact lens to 20/40. Fluid deep lamellar keratoplasty is a safe and effective procedure, especially in bilateral keratoconus, because it has no rejection complication. However, it is technically difficult with slow visual rehabilitation.