title: Microkeratome-assisted superficial anterior lamellar keratoplasty for anterior stromal corneal opacities after penetrating keratoplasty.
abstract: OBJECTIVE
  To describe the surgical technique and report the outcomes of patients treated with microkeratome-assisted superficial anterior lamellar keratoplasty for anterior stromal corneal opacities developing after penetrating keratoplasty (PK).
  
  
  METHODS
  All patients with post-penetrating keratoplasty anterior stromal opacities treated with microkeratome-assisted superficial anterior lamellar keratoplasty between July 2005 and June 2007 were reviewed. A 130-μm superficial keratectomy was performed, followed by the placement of an appropriately sized donor graft, which was secured with overlay sutures. Refraction, corneal topography, and uncorrected and best-corrected visual acuities (UCVA, BCVA, respectively) were noted at each examination.
  
  
  RESULTS
  Nine eyes of 8 consecutive patients were identified. Causes of anterior stromal opacities included dystrophy recurrence (n = 3), post-photorefractive keratectomy haze (n = 2), and scarring after stromal melt (n = 4). BCVA improved in all 9 eyes at final follow-up, and 7 of 9 eyes achieved ≥20/40 within the first month. Average follow-up period was 28 ± 3.9 months. Refractive astigmatism also improved by an average of 0.7 diopters.
  
  
  CONCLUSIONS
  Superficial anterior lamellar keratoplasty is a viable and effective alternative to repeat PK in treating anterior stromal scars. It avoids open-globe surgery and exposure to endothelial rejection associated with repeat PK, and visual rehabilitation is considerably quicker.
authors.affiliation: Department of Ophthalmology, Villa Serena Hospital, Forli, Italy.
authors.forename: Amit K
authors.initials: AK
authors.lastname: Patel
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Scorcia
authors.forename: Anju
authors.initials: A
authors.lastname: Kadyan
authors.forename: Lucia
authors.initials: L
authors.lastname: Lapenna
authors.forename: Diego
authors.initials: D
authors.lastname: Ponzin
authors.forename: Massimo
authors.initials: M
authors.lastname: Busin
mesh_terms: D000328:Adult; D000368:Aged; D001251:Astigmatism / Q000503:physiopathology; D003318:Corneal Opacity / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003319:Corneal Stroma / Q000473:pathology / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D005260:Female; D006085:Graft Survival; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012029:Refraction, Ocular / Q000502:physiology; D014792:Visual Acuity