Efficacy Of Mid Anterior Stromal Keratoplasty (Malk)

To show the safety and efficacy of Mid-anterior lamellar keratoplasty in advanced keratoconus. 

Ruby Eye Hospital, Berhampur

 

Ten patients with a grade 4 keratoconus were included in the study. All the patients were screened by performing pentacam. Pentacam reports showing grade 4 in the topometric maps were included in the study. All patients underwent Mid Anterior Stromal Keratoplasty. A 7.5 mm partial trephination was performed over the recipient cornea, which was deepened with the help of a 350 micron guarded blade. With a crescent blade, 360-degree manual dissection of the cornea was performed. Initially, the peripheral cornea was dissected; finally, the central cornea was peeled out. A 7.5 mm donor cornea was de-endothelialised and secured to the recipient cornea with 16 interrupted sutures.Sutures were removed in a graded manner over a period of 1 year

The mean pre-operative simulated keratometry was 67.2D which improved to 45.6 D with a p<0.001. The mean pre-operative uncorrected visual acuity was 1.68 log mar units which improved to 1.4 with refractive correction. Post-surgery the mean best-corrected visual acuity was 0.87 Logmar units at 1 month, 0.6 log mar at 3 months, 0.5 at 6 months and 0.26 at 12 months (p-value <0.001). The mean follow up period was 20.5 months. None of the patients had any rejection episodes. Mean refractive error at the end of 1 year was -2.5 D spherical equivalent. 

The visual outcome of Mid Anterior Lamellar Keratoplasty (MALK) was comparable to deep anterior lamellar keratoplasty (DALK) as published in the literature. Mid anterior lamellar keratoplasty has no risk of stromal perforation, avoiding the risk of full-thickness penetrating keratoplasty. However, the recovery period is delayed, which needs appropriate counselling to the patients.