Protected Penetrating Keratoplasty As An Alternative To Conventional Penetrating Keratoplasty In Cases Of High Risk Of Intraocular Contents Expulsion.

This is a clinical case where a surgical alternative to conventional penetrating keratoplasty is proposed: protected penetrating keratoplasty.
This surgical technique aims to minimize the risk of intraoperative prolapse of the intraocular structures. This is a very severe complication most often caused by hypotony or sudden changes in intraoperative pressure.

Department of Ophthalmology, Mútua Terrassa University Hospital, Terrassa, Barcelona, Spain.

The fundamental characteristic that differentiates protected penetrating keratoplasty from conventional penetrating keratoplasty is the transplantation of the donor button and the beginning of the sutures without previously removing the incompletely trephined recipient area. Once the donor cornea is already protected and fixed to the recipient cornea, the trephination is completed and safely removed. In this way, there is no complete opening of the cornea at any time and this dreaded complication is minimized. It is important to remember to use viscoelastic between the two corneas to ensure adequate endothelial protection of the graft.

We present the case of a 59-year-old male patient with a corneal leukoma secondary to herpetic stromal keratitis who was planned to undergo an anterior lamellar keratoplasty under retrobulbar anesthesia accompanied by sedation. Intraoperatively, due to poor collaboration of the patient because of insufficient sedation effect, we decided to convert the lamellar keratoplasty to a protected penetrating keratoplasty, obtaining a satisfactory result and a good postoperative evolution.

As a conclusion, protected penetrating keratoplasty is safer intraoperatively that the conventional technique as it does not compromise the integrity of the eyeball and its structures. In addition, it does not require special instruments or a longer surgical time. Therefore, it should be considered as an effective option, especially in high-risk patients.