Microkeratome-Assisted Two-Stage Technique of Superficial Anterior Lamellar Keratoplasty for Reis–Bücklers Corneal Dystrophy

Purpose: The aim of this study was to describe a microkeratome-assisted 2-stage technique of superficial anterior lamellar keratoplasty (SALK) to manage Reis–Bucklers corneal dystrophy (RBCD). Methods: A microkeratome was used to create a 9-mm, 140-&mgr;m-thick corneal flap in the first stage. Four weeks later, in the second stage, a Hessberg–Baron suction trephine was used to perform a 7.0-mm central trephination up to a depth of 150 &mgr;m, within the corneal flap. Donor lamellar tissue was prepared using a microkeratome system, after which a vacuum punch was used to trephine a 7.0-mm lamellar button. This donor button was used to replace the central corneal flap in the recipient cornea without using any sutures. A bandage contact lens was applied for 2 weeks. Results: This modified technique of staged sutureless SALK was used in 4 eyes of 2 patients with RBCD. Postoperatively, all eyes experienced an improvement in both uncorrected and best spectacle-corrected visual acuities. The average best spectacle-corrected visual acuity was 20/30 at the last follow-up (19 months, range 16–22 months). The cornea remained clear in all eyes until the last follow-up without any evidence of recurrence of RBCD. Conclusions: The staged technique of microkeratome-assisted SALK allows the replacement of superficial corneal stroma without the necessity for any sutures and seems to be a safe and effective method for the treatment of RBCD.