Central Lamellar Keratoplasty With Peripheral Intralamellar Tuck: A New Surgical Technique For Keratoglobus

Purpose. To report a new technique of lamellar keratoplasty in a case of keratoglobus. Methods. A patient with bilateral keratoglobus with maximal thinning in the juxtalimbal periphery underwent a lamellar procedure in the right eye. The visual acuity was 3/60. Refraction was not possible due to severe irregular astigmatism, and the central pachymetry was 430 &mgr;m. A central 8.5 mm diameter lamellar dissection along with a peripheral intrastromal pocket up to the limbus was fashioned. The donor corneal button (12 mm) denuded of its endothelium was beveled at the periphery to create a flange. This flange was tucked into the peripheral pocket and the graft was sutured with interrupted nylon sutures. Results. No intra-or postoperative complication was encountered. Reepithelialization was complete within 1 week. At 1 month postoperatively, the preoperative keratometric astigmatism of >12 D decreased to <2.75 D. The spectacle-corrected visual acuity at 1 month was 6/18. Conclusions. This new technique of central lamellar keratoplasty with intralamellar tucking of the peripheral flange for keratoglobus not only provides optical clarity and tectonic support but also helps in preservation of the host limbal stem cells.