"Tuck in" lamellar keratoplasty for tectonic management of postkeratoplasty corneal ectasia with peripheral corneal involvement.
OBJECTIVE
Evaluation of "tuck in" lamellar keratoplasty (TILK) for the surgical management of postkeratoplasty corneal ectasia with peripheral corneal involvement.


METHODS
Four eyes of 3 patients with post-penetrating keratoplasty corneal ectasia and contact lens intolerance underwent TILK that included a central lamellar keratoplasty with intrastromal tucking of the peripheral flange, at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia. The main outcome measures analyzed were uncorrected visual acuity, best-corrected visual acuity, keratometry, and endothelial cell density.


RESULTS
The original indication for surgery was keratoconus in all the cases. TILK was successfully performed in these patients. Mean follow-up period was 13 months (SD: 7.74) (range: 6-24 months). The preoperative best-corrected visual acuity improved from a mean value of 0.05 (SD: 0.05) to 0.34 (SD: 0.03) (P < 0.001). Mean keratometry decreased from 59.67 diopter (SD: 7.18) preoperatively to 43.50 diopter (SD: 2.23) postoperatively (P < 0.005). Mean endothelial cell loss after TILK was 5.93% (SD: 3.06) (P < 0.206). All grafts were clear at the last follow-up, and no cases of stromal or endothelial graft rejection were encountered.


CONCLUSIONS
TILK can be successfully performed for post-penetrating keratoplasty corneal ectasia with peripheral corneal thinning.
Melbourne University Department of Ophthalmology, Centre for Eye Research Australia, University of Melbourne, Australia. rasikv@unimelb.edu.au
Rasik B
RB
Vajpayee
Vishal
V
Jhanji
Jacqueline
J
Beltz
Sonia
S
Moorthy
D000293:Adolescent; D000328:Adult; D002452:Cell Count; D002648:Child; D003315:Cornea / Q000473:pathology; D003316:Corneal Diseases / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology; D005139:Eyeglasses; D006801:Humans; D007640:Keratoconus / Q000601:surgery; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D014792:Visual Acuity; D055815:Young Adult