Key Concepts Anterior lamella keratoplasty (ALK) techniques allow the surgeon to selectively dissect parts of the diseased corneal stroma while sparing the healthy remaining stroma and endothelium. The stromal dissection has to be deep (residual bed thickness <80 μm) and…
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Key Concepts Anterior lamellar keratoplasty includes techniques whereby the diseased corneal stroma is partially or totally replaced by donor tissue, provided the endothelium is still healthy. Anterior lamellar keratoplasty induces a low immunologic insult. This allows for larger grafts without…
Key Concepts A history of preexisting glaucoma or glaucoma surgery is a major risk factor for postoperative intraocular pressure (IOP) rise in eyes that have received either PK or Descemet stripping endothelial keratoplasty (DSEK) surgery. Similar mechanisms of IOP rise…
Key Concepts Infection after penetrating keratoplasty can be a serious complication and can threaten the integrity of the graft. Microbial keratitis in an eye that has undergone penetrating keratoplasty must be recognized early and treated aggressively, as it can progress…
Key Concepts Of the approximately 50,000 corneal transplants performed annually in the United States, corneal allograft rejection is still the leading cause of corneal graft failure. Young age, pre- or postoperative vascularization, preoperative inflammation, and iris synechiae to the graft-host…
Key Concepts Close follow-up after penetrating keratoplasty is critical to long-term success. Early postoperative complications include elevated intraocular pressure, wound leaks, and failure to epithelialize the new graft. Surgical factors and patient characteristics influence the success rate. Infants and young…
Key Concepts The use of femtosecond lasers in corneal transplant surgery was investigated in 2006, and since then, multiple customized trephination patterns have been conceptualized to improve wound architecture and healing. Trephination profiles, including the “top-hat,” “mushroom,” and “zig-zag,” among…
Key Concepts Intraoperative complications during penetrating keratoplasty can be related to anesthesia, fixation ring placement, trephination, damage to intraocular structures, and bleeding. Intraoperative complications are best dealt with at the time of surgery and with adequate preparation can be successfully…
Key Concepts Penetrating keratoplasty (PK) plays an important role for corneal disease not suitable for lamellar grafts. PK has excellent outcomes in terms of graft clarity, but high levels of postoperative astigmatism or anisometropia remain an issue. Risk factors for…