Objective: To evaluate the efficacy and safety of optical lamellar keratoplasty assisted by homemade-microkeratome in treating corneal opacification for optical indications.
Methods: In 12 eyes of 11 patients with corneal opacities and healthy endothelium, the homemade-microkeratome was used for the resection of corneal opacities whose depth measured by optical pachymeter preoperatively, and the donor disc was excised by the same technique. After the resection of corneal opacities, the residual bed thickness was measured by ultrasonopachymeter. The disparities in thickness and diameter between the bed and the donor disc were reduced as least as possible by the use of different suction rings and microkeratome heads. The donor disc was secured with four or eight interrupted sutures. The period of follow-up ranged from 7 to 14 months. The transparency of cornea, donor-host interface and the refractive changes after surgery were examined by slit-lamp microscopy and Keratron videokeratoscope.
Results: The slit-lamp microscopic examination showed no severe complications after surgery, all grafts appeared to be transparent without recognizable opacity in the interface except 1 eye with epithelial ingrowth and local graft melting subsequently. Visual acuities were improved in all eyes, 7 eyes had best corrected visual acuity better than 0.5 and 2 eyes reached 0.8. During the follow-up 3 to 6 months, the mean corneal refractive power significantly increased (2.36 +/- 1.25) D (P = 0.016), and the corneal astigmatism significantly decreased (0.97 +/- 0.95) D (P = 0.023) Compared with that before surgery, the increase of the corneal refractive power had negative correlation with the thickness of residual bed (r = -0.830, P = 0.004).
Conclusions: This easy, safe new technique leads to good visual results and represents a good alternative to penetrating keratoplasty in treating corneal opacities.