The authors retrospectively reviewed 23 lamellar patch grafts performed over a six-year period for tectonic indications in corneal thinning and perforations. The anterior stroma of corneal endothelium peeled for descemet membrane endothelial keratoplasty (DMEK) were used to prepare circular lamellar corneal grafts. The remaining rim of the cornea following punch trephination of donor corneas for penetrating keratoplasty (PKP) was used to prepare square-shaped grafts. Circular lamellar grafts were used in 13 eyes that had paracentral or central corneal thinning or perforations. Square-shaped grafts were used in 10 eyes, nine of which had peripheral corneal thinning or perforations, and one, limbal. Anatomical success after tectonic grafts was achieved in 22 of 23 eyes (95.6%) at a mean follow-up of 9.83 ± 6.27 months. The mean of the best-corrected visual acuity improved from logMAR 2.29 ± 0.23 preoperatively to logMAR 1.35 ± 0.2 postoperatively, at the final follow-up. Post-procedure, remelting of the graft was seen in three eyes, which then underwent a second lamellar patch graft. One patient underwent PKP after failure of the second lamellar keratoplasty (LKP). Corneal abscess was seen in two eyes, which were then treated with topical fortified antibiotic drops. Pseudochamber formation at the interface was detected in six patients. The authors conclude that the main disadvantage of patch grafts is the shortage in corneal supply due to insufficient cornea donation in developing countries like Turkey. However, with their technique utilising unused corneal rims, they report that extra corneas will not be required.
Lamellar patch grafts utilising cornea remnants from DMEK/PKP
Reviewed by Su Young
Lamellar corneal patch grafts in the management of corneal thinning and perforations without using extra corneas.
