Microkeratome-assisted lamellar keratoplasty for keratoconus:: Stromal sandwich

Purpose: To evaluate microkeratome-assisted lamellar keratoplasty for the treatment of keratoconus when it is not possible to correct the astigmatic ametropia with contact lenses. Setting: Ophthalmology Department, School of Medicine, Gazi University, Ankara, Turkey. Methods: This prospective study comprised 9 eyes of 7 keratoconus patients with contact lens intolerance. The donor cornea was prepared with a microkeratome and punched with a 7.25 mm or 7.50 mm trephine. Following the creation of a standard 9.0 mm corneal flap in the host cornea, the donor stromal button was implanted under this corneal flap like a sandwich. Transepithelial photorefractive keratectomy or laser in situ keratomileusis was performed when the corneal topography and refraction stabilized by the end of the sixth postoperative month. Follow-up ranged from 7 to 22 months. Results: All patients gained 5 or more lines (mean 7.2 lines +/- 1.6 [SD]), and no patient lost a line of vision. The mean corneal thickness was 432.7 +/- 36.1 mum preoperatively and 578.1 +/- 45.1 mum after refractive surgery. Conclusion: The early visual results of this surgical technique are promising and seem to be comparable to those with penetrating keratoplasty.