Laser intrastromal keratoplasty--case report.
OBJECTIVE
To evaluate the feasibility of correcting high hyperopia by means of intrastromal implantation of a laser shaped corneal lenticule prepared from a human donor eye.


METHODS
A female patient with high hyperopia and irregular astigmatism resulting from multiple laser in situ keratomileusis procedures and lamellar keratoplasty underwent laser intrastromal keratoplasty. Her preoperative uncorrected visual acuity (UCVA) was 20/300 and best spectacle-corrected visual acuity (BSCVA) was 20/100 with a refraction of +8.00 -1.00 x 130 degrees. Corneal topography showed a highly irregular corneal surface. Central corneal thickness was 398 microm. Lenticule preparation included mechanical de-epithelialization of a human donor eye, keratectomy with a microkeratome, user-designed software combining a photorefractive keratectomy (PRK) treatment for +8.00 D sphere, an ablation zone of 7.0 mm, and a circumferential cut (internal diameter of 6.5 mm) for tissue ablation. Implantation involved re-lifting the flap, positioning the lenticule onto the corneal bed, and repositioning of the flap.


RESULTS
The operation was uneventful as was the early postoperative follow-up. BSCVA improved to 20/50 with +1.00 -2.25 x 120 degrees at 2 months postoperatively. Corneal topography showed a more regular cornea with increased curvature in all meridians. Central corneal thickness increased to 600 microm.


CONCLUSIONS
Laser intrastroma keratoplasty may be an option for correcting high hyperopa and irregular astigmatism in eyes with a thin corneal bed.
Jankov
Mirko
M
Augenklinik, UniversitätsSpital Zürich, Switzerland. mirkojankov@hotmail.com
Mrochen
Michael
M
Seiler
Theo
T
D000328:Adult; D001251:Astigmatism / Q000601:surgery; D003319:Corneal Stroma / Q000601:surgery*; D019781:Corneal Topography; D016039:Corneal Transplantation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000209:etiology / Q000601:surgery*; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects; D054018:Lasers, Excimer; D018903:Photorefractive Keratectomy / Q000379:methods*; D012029:Refraction, Ocular; D013524:Surgical Flaps; D014792:Visual Acuity