gms | German Medical Science

Last time in the keratoconus I - II stages treatment is used deep lamellar keratoplasty.The aim of this study was to analyses optic and functional results of lamellar keratoplasty (LK) in keratoconus of III - IV stages (Amsler).

The lamellar keratoplasty (with depth 0.3-0.35 mm, diameter of grafts 7.0 - 8.5 mm) was performed at 60 patients (65 eyes) with keratoco-nus III stages (26 eyes), IV - (39 eyes) in age 10 - 32 years, mean 16.38±2.95. 42 patients (70%) were 10 –18 years old. Two patients had Down’s syndrome, 12 – atopy, two patients had mydriasis after penetrating keratoplasty in another eye. Visual acuity (VA) before LK was (0.05±0.03).

Intraoperative and after operation complications were not observed. In 3 month after LK was showed a significant increase of the corneal thickness to 0.65±0.05 mm, of the curvature radius to 7.1±0.07 mm and VA 0.3-0.85 was in 46 eyes (69.2%): without glass correction - in 30 eyes and with glass correction - in 16 eyes. In 7 eyes VA was 0.2-0.25 and not correction. In 12 eyes (4 eyes after hydrops of the cornea, 8 eyes with another diseases of eye) VA was 0.1-0.17. The average astigmatism was (-1.37±2.96) D, spherical equivalent – (-2.25±3.86) D. We have long-term results of LK of follow -up from 1 –10 years at 55 patients (60 eyes - 92.3%). VA 0.3 –1.0 was in 41 cases (63.1%): in 22 eyes - without correction, in 19 eyes - with glass correction, in 7 cases – contact correction. The average astigmatism was (-2.74±1.67) D, spherical equi-valent – (-3.62±1.46) D. Decrease thickness of the cornea to (0.55±0.04) mm and decrease the curvature radius to (6.9±0.04) mm. Graft was transparent in 100% cases. In 3 – 4 years after LK in 5 eyes (8.3%) penetrating keratoplasty was performed.

Our data show, that LK is an effective method for the correction of ametropia in III - IV stages of keratoconus and could be used as a therapeutic and tectonic keratoplasty before penetrating keratoplasty. Lamellar keratoplasty in such cases can be alternative to PK, because the risk of complications after LK is much less and transplant transparency is much more stable.