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First Author: M.Frolov RUSSIA
Co Author(s): V. Kumar K. Ksenia A. Frolov
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The Department of Ophthalmology of Peoples Friendship University of Russian for surgical correction of myopia and astigmatism of high degrees has devised a method of the interlamellar circular, tunnel and sectoral keratoplasty. The purpose of the study: to analyze the possibilities and results of interlamellar refractive keratoplasty for correction of high myopia and astigmatism.
Interlamellar keratoplasty is applied in clinical settings for correction of high myopia from 8.5 diopters up to 17.0 diopters; simple, complex myopic and mixed astigmatism from 3.5 diopters up to 9.5 diopters. In total 140 operations were performed on 99 patients with follow-up period up to 15 years. In 96.83% of cases transparent engraftment of the implants was achieved. As the material for operation we used donor cornea, if there were no contraindications for the use of the cornea. Donor eyes were treated in two portions of aqueous solution of brilliant green (1:2000) and then in the aqueous two-component solution (0.025% chlorhexidine and 0.015% gentamicin) for 10 minutes. At a given depth the cornea was split with special corneal spatula over the entire area in the same layers. With the help of the special knife with two blades we made parallel cuts through the entire depth of the bundle. The sizes of alloimplants were determined by specials gaskets with thickness from 0,3 to 0,85 mm and by a depth of stratification of the cornea.
interlamellar circular keratoplasty for myopia: we formed a ring-shaped tunnel and placed there two band-like alloimplant. The dosage of refractive effect was determined by size of cross-sectional dimension of alloimplantats and by the diameter of the formed ring. interlamellar tunnel keratoplasty applied for astigmatism. Cornea was marked on sectors. We made tangential corneal incisions. Stratification was produced at a given depth, ended at boundary of the marked optical zone. Into the tunnel we placed implants. later we made relaxing incisions between alloimplants. flattening of optical zone and alignment of posterior surface were observed immediately. interlamellar sectoral keratoplasty applied for simple myopic and mixed astigmatism. we made two incisions of the cornea to a determine depth, depending on clinical refraction. incisions were diametrically opposed to each other. we made sectoral tunnel splitting of the cornea in length of 1 / 4 circle marked. there two predried alloimplantats were implanted at a depth of 0.2 mm. anterior layers of the cornea sagged outwards and, consequently, optical zone became more flat. For mixed astigmatism the implantation was made at a depth of 0.4 mm along the flattest principal meridian. its radius of curvature decreased, compensatory radius of curvature of the steepest, meridian increased.
In 75 cases (54,3%) of interlamellar keratoplasty we achieved visual acuity without correction 0.6-1.0, in 43 cases (30.7%) 0.3. - 0.5 and in 21 cases (15.0%) 0.1-0.2, that was equal to the maximum visual acuity with correction before surgery. In 8 cases (5.7%) a residual astigmatism from +1.25 diopters to -3.5 diopters was noted. In 6 cases (4.3%) a reoperation was performed to replace alloimplantats for enhancing of the refractive effect. The highest refractive effect in correction of myopia was up to 15.0 diopters, in correction of complex myopic astigmatism up to 6.5 diopters (the steepest meridian), and for myopic astigmatism arising after penetrating keratoplasty up to 9.5 diopters. In correction of mixed astigmatism the refraction effect was 7.5 diopters. Stabilization of the refractive effect was completed in 3-4 months after surgery. The significant advantages of the interlamellar keratoplasty are: small trauma, lack of deep incisions of the cornea, the intact optical center of the cornea 6,0 mm, controllability of the refractive effect by replacing of alloimplants or their complete removal, if it is necessary, without any consequences for cornea.
Interlamellar keratoplasty is still an effective, simple and safe method of surgical correction of refractive errors and it deserves a wide application in clinical practice.