A modified technique for selective stromal transplantation

Deep anterior lamellar keratoplasty and penetrating keratoplasty (PKP) are the operations of first choice for pathological changes of the cornea localized in the stroma or incurable pathology of the corneal stroma. The importance of restoring corneal transparency and increasing visual acuity prevail over the well-known disadvantages of these techniques. In case of isolated corneal stroma pathology we have previously proposed a new type of closed keratoplasty – selective optical transplantation of the stroma (oSTS). The oSTS technique is devoid of intraocular complications, penetrating wound, sutures, keeps corneal surfaces intact, excludes complications related to epithelialization, optimizes rational use of available donor corneal tissue. However, as time has shown, the stromal resection stage in oSTS turned out to be technically complicated for routine and wide application.

Purpose of the study: to develop a modified (simplified) surgical technique of oSTS.

Material and methods. Modified STS (mSTS) was performed in 4 patients (age 48 ± 10 years) with lattice corneal dystrophy. The follow-up period amounted to 8.0 ± 1.3 months. Refractometry, visometry, biomicroscopy, keratoanalysis, optical coherence tomography of the cornea were performed before the operation and at fixed periods after it. We evaluated the necessity for the use of cutting instruments and the duration of extraction step of the recipient’s resected corneal stroma in both at original oSTS and mSTS.

Results. The mean duration of the extraction step in mSTS was 336.0 ± 43.7 s, whereas in oSTS it was 838.0 ± 233.5 s. No additional cutting instrument was used in the mSTS, compared to 75 % of patients in the oSTS.

Conclusion. In mSTS the duration of the most complicated stage, namely, the stage of extraction of the recipient corneal stroma, is significantly reduced, which potentially makes the technique routine and more accessible to a wide range of ophthalmic surgeons.

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