REPLAY - Which Anterior Lamellar Keratoplasty procedure to choose for which pathology?

For the last decades, penetrating keratoplasty (PK) has been the corneal reparative technique of choice, while lamellar keratoplasty has been done relatively rarely. Even nowadays, more than half of corneal surgeries worldwide are « perforating » (PK), while indications don’t always justify to remove the patient’s whole cornea and take the risk of an open-sky procedure.

More specifically, several pathologies only involve the patient’s stroma, and sometimes a part of it, bringing Anterior Lamellar Keratoplasty (ALK) techniques to the forefront more than ever: keratoconus, post-LASIK keratectasia, pellucid marginal degeneration, stromal keratitis, scars, infections, etc.

The advantages of ALK techniques compared to PK are many: rejection almost never occurs as patient still benefit from his own corneal endothelium, eye banks are able to provide donor tissue more easily, earlier suture removal is usually possible, and postoperative optics are consistent with an optimal visual rehabilitation.

Deep ALK (DALK) is probably the predominant technique among ALK, but microkeratome-assisted procedures bring an added value to a corneal practice: Superficial ALK (SALK), Automated ALK (ALTK), Hemi-automated ALK (HALK) are part of leading corneal surgeons’ arsenal too.

 

All those ALK techniques require surgical interventions and equipment that are different from those most corneal surgeons were originally taught with PK, and this webinar provides a complete overview to better understand and acquire those techniques:

• Namrata Sharma, MD, PhD from AIIMS, Delhi (India) will detail microkeratome-assisted SALK & ALTK techniques when pathology is not too deep
• Jodbhir S. Mehta, MD, PhD from SNEC (Singapore) will explain HALK, an hybrid ALK technique in corneas with topographical irregularities
• then Alaa El-Danasoury, MD, PhD from Magrabi Hospital, Jeddah (Saudi Arabia) and Luigi Fontana, MD, PhD from Italy will show how accessible the big-bubble DALK is with Moria adjustable trephine & delicate instruments

Eye surgeons, more especially anterior segment/corneal surgeons