Surgical technique of keratoplasty with simultaneous implantation of a continuous ring or ring segment into the graft

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Deep anterior lamellar keratoplasty in extrusion of an incomplete intrastromal corneal ring segment (clinical observation). Russian Annals of Ophthalmology. 2023;(1):75-79

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The article presents the surgical technique of penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) with femtosecond-laser assistance involving simultaneous implantation of an intracorneal continuous ring (ICCR) or an intracorneal ring segment (ICRS) into the graft. Surgical technique no. 1 — keratoplasty with simultaneous implantation of ICRS. Intrastromal circular tunnel is formed in the central zone of donor cornea using femtosecond laser. Then penetrating trepanation 8.1 mm in diameter is performed symmetrically to the formed tunnel. After preparing penetrating or lamellar recipient bed, suture fixation is placed in the corneal transplant, then the ICRS is implanted into the graft. Surgical technique no. 2 — keratoplasty with simultaneous implantation of ICCR. The donor cornea is dissected from periphery to center using femtosecond laser. Central zone remains untouched. A large diameter full-thickness trepanation is performed and the donor cornea is divided into the anterior and posterior layers. The ICCR is put on the donor cornea while holding the posterior layer with forceps. Penetrating or lamellar recipient bed is prepared, then the corneal graft is fixed with sutures. Transparent corneal graft acceptance does not guarantee high visual acuity due to post-keratoplasty astigmatism. Surgical correction of astigmatism is performed in the long term post-operatively and isn’t effective enough. We proposed this new surgical technique of keratoplasty with simultaneous implantation of ICCR and ICRS into the graft as close as possible to the visual axis of the eye, which can help make the postoperative astigmatism minimal both immediately after surgery and in the long term. The study proposes a new approach to intraoperative prevention of post-keratoplasty astigmatism. The technique is simple, safe and effective. Analysis of long-term outcomes is required before recommending this method for widespread use in clinical practice.

Keywords:

penetrating keratoplasty

deep anterior lamellar keratoplasty

intracorneal continuous ring

intracorneal ring segment

post-keratoplasty astigmatism

Authors:

Yu.Yu. Kalinnikov

A.I. Yevdokimov Moscow State University of Medicine and Dentistry;
Clinical Hospital of the Presidential Administration

ORCID: 0000-0001-7624-7163

S.Yu. Kalinnikova

The S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery”

ORCID: 0000-0002-9109-2400

T.H.A. Dinh

A.I. Evdokimov Moscow State University of Medicine and Dentistry;
Vietnam National Eye Hospital

ORCID: 0000-0002-1774-3439

L.F. Ragimova

A.I. Yevdokimov Moscow State University of Medicine and Dentistry

ORCID: 0000-0003-3441-5434

Received:

24.03.2023

Accepted:

02.06.2023

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