Current Indications for Penetrating Transplantation in Keratoconus

Abstract

Penetrating transplant (PT) of the cornea is the oldest transplant technique and for a long time was the only surgery available for certain cases. This technique consists of replacing the entire thickness of the cornea, while lamellar transplants replace only the lamellar or deep lamellar portion.

With the implementation of new resources, such as contact lenses made from excellent materials that are increasingly compatible with corneal physiology, intra-stromal rings, combined with cross-linking, among other available tools, penetrating transplants are less and less indicated.

In special cases, such as when Descemet’s membrane ruptures, the combination of keratoconus and low endothelial cell count, diffuse opacities, deep leucoma and corneal thickness less than 250 microns at the apex of the cornea, penetrating keratoplasty is a great treatment option surgical procedure with good results. However, this should be the last and inevitable treatment option to be performed.

Everything in the treatment of keratoconus involves the importance of patient education and sharing information with the patient.

Each case is unique and must be very well studied, being necessary a tripod composed of a multimodal propedeutics (with a good evaluation of the slit-lamp, topographic, and tomographic study), transparency with the patient, and knowledge to indicate the best treatment for that case.