Two-step keratoplasty for deep vascularized corneal opacity with severe peripheral thinning following Acanthamoeba keratitis.

PURPOSE: In cases of corneal opacity with vascularization and peripheral thinning, traditional keratoplasty techniques have several risks and drawbacks. We report the results of a two-step surgical strategy consisting in performing a large diameter tectonic lamellar keratoplasty (TLK) to restore appropriate corneal thickness and an avascular recipient bed, followed by central optical PK within the lamellar graft at a later date.

METHODS

This single-institution study analyzes the results of 7 eyes of 7 patients who received PK after large diameter TLK. All patients were affected by deep post-infectious corneal opacity with persistent stromal vascularization and peripheral thinning. The main outcomes measured were graft survival, visual acuity, refraction, and endothelial cell density.

RESULTS

TLK was performed in all cases with 10/10.1-mm diameters. After a mean interval of 14 months, central PK was performed with a median host-graft diameter of 7.75/8.25 mm. Mean follow-up after PK was 52 months. At last follow-up, 6/7 (86%) grafts were clear. Endothelial rejection occurred in 5/7 (71%) eyes, with one patient having multiple episodes and subsequent graft failure. At 2 years, all patients had a visual acuity ≥ 20/40, with an average refractive astigmatism of 3.75 diopters.

CONCLUSION

Optical PK within a previous TLK is a safe and efficient technique for treating deep corneal opacity associated with extensive vascularization and peripheral thinning. Extended follow-up period is necessary to assess endothelial cell loss and long-term efficacy of the procedure.