Microkeratome-assisted lamellar keratoplasty for keratoconus: stromal sandwich

To evaluate microkeratome-assisted lamellar keratoplasty for the treatment of keratoconus when it is not possible to correct the astigmatic ametropia with contact lenses. Ophthalmology Department, School of Medicine, Gazi University, Ankara, Turkey. This prospective study comprised 9 eyes of 7 keratoconus patients with contact lens intolerance. The donor cornea was prepared with a microkeratome and punched with a 7.25 mm or 7.50 mm trephine. Following the creation of a standard 9.0 mm corneal flap in the host cornea, the donor stromal button was implanted under this corneal flap like a sandwich. Transepithelial photorefractive keratectomy or laser in situ keratomileusis was performed when the corneal topography and refraction stabilized by the end of the sixth postoperative month. Follow-up ranged from 7 to 22 months. All patients gained 5 or more lines (mean 7.2 lines ± 1.6 [SD]), and no patient lost a line of vision. The mean corneal thickness was 432.7 ± 36.1 μm preoperatively and 578.1 ± 45.1 μm after refractive surgery. The early visual results of this surgical technique are promising and seem to be comparable to those with penetrating keratoplasty.