“Tuck In” Lamellar Keratoplasty (TILK) for Post-Keratoplasty Corneal Ectasia

involving the Corneal Periphery

Vishal Jhanji, MD1,2

Jacqueline Beltz, MBBS, FRANZCO2

Sonia Moorthy, MBChB2

Rasik B Vajpayee, MS, FRCS (Edin), FRANZCO2

1The Chinese University of Hong Kong

2Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Australia

The authors have no financial interest in the subject matter of this poster

BACKGROUND

• Post-keratoplasty corneal ectasia has been known to occur many years after the primary surgery in cases with keratoconus

• The ectasia as well as thinning may involve the donor, graft host junction or the host tissue beyond the graft host junction, causing severe astigmatism and irregular corneal contour, making contact lens fitting very difficult

PURPOSE

• Repeat penetrating keratoplasty (PKP) involves use of a larger graft and its inherent complications like glaucoma and increased risk of endothelial rejection

• We describe Tuck-In Lamellar Kertaoplasty (TILK) for the surgical management of cases with post-PKP corneal ectasia beyond the graft-host junction

METHODS

• Retrospective chart review was conducted for all patients with that underwent TILK for post-PKP ectasia at the Royal Victorian Eye and Ear Hospital, Melbourne

• Data collected included preoperative and postoperative UCVA, BCVA, endothelial cell density, keratometry, and endothelial cell density

METHODS: SURGICAL TECHNIQUE

Donor Preparation• A Hessburg Barron vacuum trephine was used to make

an initial partial thickness groove of 200-250 microns. The anterior lamellar disc was excised and a pocket was made circumferentially in the corneal periphery up to 0.5 mm posterior to the limbus

Preparation of graft• An initial partial thickness incision up to a depth of 300

microns was made using a 9-9.5 mm trephine followed by a lamellar dissection peripheral to the trephine cut. Donor lenticule consisting of central 9-9.5 mm full-thickness graft with a peripheral partial thickness flange of about 2.0 mm was fashioned

“TUCK IN” LAMELLAR KERATOPLASTY

Flange of donor lenticule was tucked into peripheral intrastromal pocket of host

RESULTS

RESULTS

• TILK was performed in four eyes of 3 patients with post-PKP corneal ectasia beyond the graft host junction

• The original indication for penetrating keratoplasty was keratoconus

• Average number of years since the original surgery was 25 ±13.63 (range: 10 to 43 years)

• The mean age of the patients was 34.3 (SD 11.84) years

RESULTS

• Mean follow-up period was 13 months (SD 7.74) (range 6-24 months)

• All the grafts were clear at the last follow-up visit and there was no evidence of ectasia

• Postoperatively, the UCVA, BCVA and keratometry improved significantly (p<0.05) [Table]

PreopUCVA

PostopUCVA

PreopBCVA

PostopBCVA

PreopKm (D)

PostopKm (D)

PreopECD (/mm2)

PostopECD(/mm2)

0.001 0.1 0.1 0.33 55.4 44.0 1735 1422

0.01 0.25 0.01 0.33 54.8 46.4 1125 951

0.01 0.13 0.01 0.40 58.3 41.3 1489 1302

0.1 0.20 0.1

0.33 70.2 42.3 1584 1320

RESULTS(Average values)

CONCLUSIONS

• TILK can be successfully performed for post-penetrating keratoplasty corneal ectasia with peripheral corneal thinning

IMPORTANT READINGS

• Abelson M, Collin H, Gillette T, et al. Recurrent keratoconus after keratoplasty. Am J Ophthalmol 1980; 90:672–676

• Kaushal S, Jhanji V, Sharma N, et al. "Tuck In" Lamellar Keratoplasty (TILK) for corneal ectasias involving corneal periphery. Br J Ophthalmol 2008; 92:286-90

CorrespondenceProf Rasik B Vajpayee, MS, FRCS (Edin), FRANZCO

Royal Victorian Eye and Ear HospitalCentre for Eye Research Australia, University of Melbourne

32, Gisborne Street, East MelbourneVictoria 3002, Australia

Tel: 61 3 9929 8368Fax: 61 3 9662 3959

Email: rasikv@unimelb.edu.au