Optical pachymetry-guided custom excimer laser-assisted lamellar keratoplasty for the surgical treatment of keratoconus.
OBJECTIVE
To evaluate the anatomic and functional results of optical pachymetry-guided custom excimer laser-assisted lamellar keratoplasty in keratoconus patients.


METHODS
Eye Clinic, University of L'Aquila, L'Aquila, Italy.


METHODS
Prospective noncomparative case series.


METHODS
Patients with keratoconus having unilateral surgery using custom excimer laser-assisted lamellar keratoplasty were evaluated. A transepithelial excimer laser ablation was planned to leave an estimated uniform thickness residual stromal corneal bed of 200 μm. The donor lamella was prepared with the excimer laser and subsequently sutured to the host cornea using 16 single 10-0 nylon sutures. The eyes were examined preoperatively and 3, 6, 12, and 24 months postoperatively. Outcome measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, computerized videokeratography, pachymetry, and endothelial specular microscopy.


RESULTS
Of the forty-three treated eyes, 35 were available at the 24-month follow-up visit, at which time the UDVA was better than 20/60 in 16 patients (45.7%) and the CDVA was 20/40 or better in 31 patients (88.6%). The mean refractive astigmatism was -2.11 diopters (D) (P<.05) and the mean spherical equivalent manifest refraction, -2.60 D (P<.05). No statistically significant changes in mean corneal endothelial cell density were observed postoperatively. In 1 case, the donor lamella was exchanged secondary to an altered reepithelialization process with initial corneal melting.


CONCLUSIONS
Two-year findings indicate that pachymetry-guided custom excimer laser-assisted lamellar keratoplasty is a useful surgical treatment for moderate to advanced keratoconus, preventing the need for the more invasive procedure of penetrating keratoplasty.
University of L'Aquila, Department of Surgical Sciences, Eye Clinic, L'Aquila, Italy. lspadea@cc.univaq.it
Leopoldo
L
Spadea
Riccardo
R
Gizzi
Nicole
N
Evangelista Conocchia
Sara
S
Urbano
D000328:Adult; D002452:Cell Count; D019781:Corneal Topography; D016039:Corneal Transplantation; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000601:surgery*; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult