Abstract
P 028
Musroom lamellar keratoplasty – exchanging of reversed foot
Toam Katz1, Stephan Johannes Linke1, Maren Klemm1, Gisbert Richard1, Massimo Busin2
1Universitäts-Augenklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, 2Department of Ophthalmology, Villa Serena Hospital, Forli, Italy
Objective
to describe a case of correcting a mushroom shaped lamellar keartoplasty with an upside down posterior lamella
Methods
A 37-year-old male keratoconus patient with central corneal scarring and minimal pachymetry of 229 micron underwent a mushroom shaped lamellar penetrating keratoplasty, using manual lamellar dissection and trephanation of the recipient cornea, and a mechanical automated keratectomy (Moria, France) of the donor cornea ,The mushoom shaped transplant consisted of a 9 mm diameter 200 micron thick anterior epithelial stromal lamella, and a 6.5 mm diameter posterior endothelial stromal lamella marked with ink on the endothelial side. The anterior lamella was sutured with 2 running sutures. The posterior lamella was attached to the anterior lamella with air bubble support. Short postoperatively good adaptation of the anterior and posterior lamella was seen. One month post surgery the posterior stromal lamella was clear but the anterior lamella had persistant stromal edema and developed bullous keartopathy.partial disadaptation of the 2 lamellae did not resolve with air injection into the anterior chamber. Further examination using a confocal microscopy (Rostock cornea modul) and mirrored residual ink marking between the lamellae prooved the diagnosis of a reversed posterior lamella with the endothelial side facing the anterior lamella and the stromal side facing the anterior chamber. Both lamellae were well adapted but the anterior lamella showed persistant edema in spite of 2 months of intensive local and systemic steroid therapy. A revision surgery was performed. The reversed deep lamella was removed through a 3.2 mm corneal tunnel and adapted to the older anterior lamella with an air bubble.
Results
The new posterior lamella adapted well with resolution of the anterior lamellar edema and bullous keratopathy and with improvement of the visual acuity.
Conclusions
An endothelial stromal posteior corneal button can be vital even when reversly implanted for at least 2 months. The posterior lamella can be successfully exchanged through a clear corneal tunnel without opening the anterior lamella. A clear intraoprative marking of the endothelial lamellar side is advised intraoperatively.
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