Abstract
P 027
Anterior lamellar keratoplasty using the Gebauer motorized microkeratom
Toam Katz, Gisbert Richard, Stephan Johannes Linke
Universitäts-Augenklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg
Objective
To describe a technique of anterior lamellar keratoplasty using an automated microkeratom system of Gebauer, Germany
Methods
An automated microkeratom system by Gebauer,Germany uses an artificial anterior chamber and a single use cutting head and vacuum ring to create a free corneal flap of 110, 130, 250, 350 or 400 micron thick and can be used for anterior or posterior lamellar keartoplasty. A 48 year old woman with an old superficial corneal herpetic scar in her left eye had an anterior lamellar keratoplasty surgery using a 250 micron head. The corneoscleral button was attached to a Gebauer anterior chamber under hydrostatic pressure of 90 cm H2O. An applanation plate was used to predict a flap diameter of 9 mm.. The microkeratom electric motor was protected with a sterile metal cover and performed a lamellar cut. The same cutting head was attached to a single use vacuum ring placed on the recipient cornea and used to cut a free flap containing the scar. The donor lamella was secured on the stromal bed with 2 tangential triangular sutures. Pre operative and post operative systemic Acyclovir therapy was used.
Results
The donor lamella was oval 7 to 8 mm in diameter. The stromal bed was round. The interface healed transparently, without interface keratitis or anterior lamella dislocation. No sign of herpetic keratitis was seen. The tangential sutures were removed after 3 weeks.The anterior lamella produced central corneal steepening with resultant high astigmatism.
Conclusions
The Gebauer microkeratom and artificial chamber can produce a flap for anterior lamellar keratoplasty. A learning curve is needed to produce the desired flap size. The procedure is technically simple and fast. Tha lamellar technique allowes future flap lift for excimer laser refractive stromal ablation.
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