Keratoplasty options
Despite the transformation in recent years, there is still room for PK in corneal transplantation
Dermot McGrath
Published: Wednesday, March 1, 2017
PK remains a useful option for certain indications such as full-thickness corneal scarsNevertheless, PK remains a useful option for certain indications such as full-thickness corneal scars because of abnormalities involving all layers of the cornea, severe corneal trauma, or after the resolution of infectious keratitis involving all layers of the cornea, said Dr Fournié. “Corneal imaging is also very useful in some cases to assess corneal thickness and the depth of the diseased cornea to help us choose between different techniques,” he added. For paediatric keratoplasty, most indications now call for lamellar procedures, said Dr Fournié, with some notable exceptions including Peters anomaly or sclerocornea. “In such cases PK can be very useful and successfully restore corneal transparency and visual function, even if we still have some concerns about the long-term graft survival,” he said. He noted that paediatric keratoplasty should be performed as soon as necessary to correct amblyopia but as late as possible to ensure better patient cooperation and reduced complications. “We know that we have decreased graft survival with young patients and especially for children under the age of five and especially during the first 24 months,” he said. Beyond paediatric keratoplasty, PK is also the preferred procedure in cases where a temporary keratoprosthesis has been used for retinal detachment repair. The prosthesis is replaced with a PK graft after completion of the retinal procedure which usually works quite well, he said. Although lamellar techniques such as Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemet’s membrane endothelial keratoplasty (DMEK) are now preferred for most diseases involving endothelial dysfunction, PK may still be an option for certain indications, said Dr Fournié. He cited examples such as eyes with long-standing chronic corneal oedema and significant corneal scarring, and particularly cases of diffuse corneal stromal opacity. PK may also be an option in ‘complicated’ eyes such as those with open communication between the anterior and posterior segments (large iridectomy and aphakia). Although deep anterior lamellar keratoplasty (DALK) is now the preferred technique in keratoconus, some exceptions where PK might be employed include post-hydrops cases when Descemet’s membrane cannot be bared, with central corneal scarring or persistent corneal oedema. PK can also be used in eyes with concomitant keratoconus and endothelial abnormality such as Fuchs’ dystrophy or posterior polymorphous dystrophy, concluded Dr Fournié. Pierre Fournié: fournie.p@chu-toulouse.fr
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