Microkeratome-Assisted Sutureless Superficial Anterior Lamellar Keratoplasty For Pediatric Anterior Corneal Stromal Disease

To report a case of microkeratome-assisted sutureless superficial anterior lamellar keratoplasty (SALK) in a pediatric patient with a vascularized anterior stromal scar.

Department of Ophthalmology, Ospedali Privati Forlì “Villa Igea” (Forlì, Italy).

A five-year-old female with bilateral congenital corneal opacity presented to the clinic with preoperative visual acuity of 20/200 in the right eye and counting fingers at 3 feet in the left eye and bilateral alternating esotropia and nystagmus. A dense white 4x6mm paracentral corneal opacity involving the visual axis associated with perilimbal corneal neovascularization was noted on the left eye. Anterior-segment OCT showed that corneal scar involving up to 120 µm in depth. The sutureless microkeratome-assisted SALK was performed in the left eye. Briefly, the recipient cornea was cut using a 130µm microkeratome head to obtain an anterior free cap. A 9mm anterior lamella prepared using a 90µm microkeratome head was placed onto the recipient bed without sutures. One month after SALK, best corrected VA improved to 20/80. The cornea appeared clear with no signs of interface haze, infection, recurrence, immunologic rejection or graft failure.

In conclusion, microkeratome-assisted sutureless SALK offers significant advantages in pediatric patients, including shorter operative and anesthesia time, avoidance of suture-related complications, faster visual rehabilitation crucial for amblyopia therapy, and reduced open-sky surgical risks with elimination of lifelong endothelial rejection. It may therefore be considered a valuable treatment option for children with dense isolated anterior stromal scars associated with corneal neovascularization.