Keratoplasty is a surgical intervention that results in the replacement of the entire thickness of the cornea, or its individual layers, with a donor cornea (graft).
There is penetrating keratoplasty: the entire thickness of the cornea, all its layers are replaced, and selective keratoplasty is the replacement of certain layers of the patient’s cornea - anterior or posterior.
Indications:
During a end-to-end transplant, the patient's defective cornea is cut out into a disk of a certain diameter using a special trephine, all layers of the cornea are removed, after which the patient's cornea is replaced with a similar disk from the donor graft.
Next, the donor cornea is fixed using interrupted and/or twisted corneal sutures.
Removal of the suture results for a period of 9-15 months after surgery.
Indications:
When deep anterior lamellar keratoplasty occurs, the anterior layers of the cornea are replaced, while its posterior layers (endothelial cell layer and Descemet's membrane) remain intact. This type of keratoplasty is applicable in cases where the pathology does not cover the deep structure of the cornea.
Similarly, with penetrating keratoplasty, the patient’s damaged corneal disc of a certain diameter is cut out, replaced with a donor graft and fixed with a corneal suture.
The advantages of anterior deep lamellar keratoplasty are a reduced risk of graft rejection and a reduced risk of intra- and postoperative operations.
Indications:
Until the 21st century, the main method of treating corneal endothelial dysfunction was penetrating keratoplasty, but with the development of technology, it became possible to carry out selective transplantation of only the posterior layers of the cornea, which are processed in the pathological process.
Posterior lamellar keratoplasty is the replacement of a damaged layer of endothelial cells on a thin disc of a donor cornea.
The first stage of the operation involves removing the patient's endothelial layer and Descemet's membrane through small incisions.
Next, a transplant is cut out from the prepared donor material, which is a thin disc-corneal tissue - endothelium (a layer of endothelial cells), Descemet's membrane and a small layer of corneal stroma.
After implantation of the graft into the anterior chamber of the eye, it is fixed using air or a gas-air mixture. Upon completion of the operation, only a few interrupted sutures are placed on the corneal incision.
The time frame for removing steering sutures is 3-5 months.
The advantages of performing posterior lamellar keratoplasty are:
The risk of intra- and postoperative operations is reduced compared to end-to-end corneal transplantation.
