Deep lamellar keratoplasty with the guided trephine system for transplanting full thickness donor tissue

Background: Despite the fact that deep lamellar keratoplasty (DLKP) is less invasive than to penetrating keratoplasty (PKP), this procedure is rarely performed. We therefore investigated whether or not the DLKP technique we employed can achieve stable improvement of visual acuity. Materials and methods: Thirty-three eyes underwent TLKP for treatment of superficial corneal pathology. The donor tissue transplanted was suitable for PKP. The donor lenticule was obtained on the artificial chamber of the guided trephine system (GTS). The recipient cornea was trephined with the same trephine to a depth of 680 mu m. Manual dissection was performed with a bevel-up blade. The donor lenticule with the endothelium peeled off was then sutured in with a 10 x 0 nylon double-running antitorque suture. Cortisone-antibiotic eye drops were administered postoperatively. Results:Throughout the series no complications occurred. The mean best corrected visual acuity (BSCVA) over glasses was 0.29 ( +/- 0.21) preoperatively, 0.1 (+/- 0.11) at 1 week, 0.33 (+/- 0.14) at 1 month, 0.5 ( +/- 0.13) at 6 months, 0.61 ( +/- 0.16) at 1 year and 0.63 ( +/- 0.15) at 2 years. Clinically, we observed two subpopulations. In the first group of 87 % of the cases, mean BSCVA was 0.67 (+/- 0.07) at 6 months. The remaining cases (BSCVA less than or equal to 0.25 at 6 months) achieved a mean BSCVA of only 0.2 ( +/- 0.04) at 1 year. Mean corneal astigmatism measured 2.93 D (+/- 1.62) preoperatively, 2.69 D ( +/- 1.18) at 1 month, 2.09 D (+/- 1.07) at 1 year, and 2.22 D (+/- 1.71) at 2 years. We did not observe any graft rejection. C onclusion: The technique reported for DLKP provides excellent matching of donor lenticule and recipient bed. Separation of donor and recipient stroma prevents interface healing. DLKP appears to be a safe procedure for the surgical treatment of superficial corneal pathology and may offer a clinically applicable alternative to PKP.