Changing techniques and indications for lamellar keratoplasty.

In recent decades, the number of lamellar keratoplasties (LKs) being performed worldwide has been gradually decreasing. However, new technical procedures have been developed and microsurgeons must consider modified indications for lamellar grafting. In the period 1946-1995, in the Department of Ophthalmology University Medical School of Debrecen, Hungary 3889 consecutive keratoplasties were performed of which 608 were LKs. In the period 1946-1960 special surgical material (biosutures) was used without operating microscopes and the leading indication for LK was corneal scar (leukomas). Between 1961 and 1979 with the development of microsurgical procedures (10/0 nylon sutures, operating microscope), the LK technique became more advanced. In the period 1979-1995 precision lamellar grafting could be performed with the widely available improved modern techniques. Changing indications for LK were noted in the second period and this tendency has subsequently continued. Currently the main indications for LK are "immediate" keratoplasty after chemical burns, and sclerokeratoplasty against recurrent pterygia. Their observations lead the authors to conclude that the possible reasons for the changing indications of LK are the new technical procedures, the increasing knowledge, the better immunological tests and the improved postoperative therapy.