Abstract
Corneal transplantation is the oldest, most common, and most successful transplantation in humans. The first penetrating keratoplasty (PKP) was performed in 1905 by Eduard Zirm. In recent years, an increase in lamellar procedures in corneal surgery has been observed. With the increasing expertise of the microsurgeon, the technique of PKP exceeds by far the simple replacement of two collagen discs and is crucial for achieving good postoperative visual acuity. This chapter aims to introduce the concept of nonmechanical and noncontact excimer laser-assisted keratoplatsy—“penetrating keratoplasty excimer-PKP” and deep anterior lamellar keratoplasty “excimer-DALK”. Furthermore, in this chapter, we want to highlight the important factors besides a clear postoperative transplant after PKP/ DALK, which plays an essential role in postoperative astigmatism.
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References
Zirm E. A successful total keratoplasty. Graefes Arch Clin Exp Ophthalmol. 1906;64:580–93.
Naydis I, Klemm M, Hassenstein A, Richard G, Katz T, Linke SJ. Postkeratoplasty astigmatism. Comparison of three suturing techniques. Ophthamologe. 2011;108:252–9.
Seitz B, Daas L, Milioti G, Szentmáry N, Langenbucher A, Suffo S. Excimer laser-assisted penetrating keratoplasty: on 1 July 2019 excimer laser penetrating keratoplasty celebrates its 30th anniversary. Ophthalmologe. 2019;116:1221–30.
Artana LG. Computerized corneal topography in the treatment of high astigmatism after penetrating keratoplasty. Klin Monatsbl Augenheilkd. 1995;206:312–6.
Seitz B, Langenbucher A, Naumann GOH. The penetrating keratoplasty. A 100-year success story. Ophthamology. 2005;102:1128–36.
Riedel T, Seitz B, Langenbucher A, Naumann GOH. Morphological results after eccentric penetrating keratoplasty. Ophthalmologe. 2001;98:639–46.
Naumann GOH. Part II: corneal transplantation in anterior segment diseases. The Bowman Lecture (Number 56) 1994. Eye. 1995;9:395–421.
Seitz B, Szentmáry N, El-Husseiny M, Viestenz A, Langenbucher A, Naumann GOH. The penetrating keratoplasty (PKP) – a century of success. In: Hjortdal J, editor. Corneal transplantation. Berlin: Springer; 2016. p. 67–92.
Hoppenreijs VPT, Van Rij G, Beekhuis WH, Rijneveld WJ, Rinkel-Van DE. Causes of high astigmatism after penetrating keratoplasty. Doc Ophthalmol. 1993;85:21–34.
Naumann GOH, Sautter H. Surgical procedures on the cornea. In: Blodi FC, Mackensen G, Neubauer H, editors. Surgical ophthalmology. Berlin: Springer; 1991. p. 433–97.
Olson RJ. Modulation of postkeratoplasty astigmatism by surgical and suturing techniques. Int Ophthalmol Clin. 1983;23:137–51.
Van Rij G, Cornell FM, Waring GO III, Wilson LA, Beekhuis H. Postoperative astigmatism after central vs eccentric penetrating keratoplasties. Am J Ophthalmol. 1985;99:317–20.
Van Rij G, Waring GO. Configuration of corneal trephine opening using five different trephines in human donor eyes. Arch Ophthalmol. 1988;106:1228–33.
Behrens A, Seitz B, Küchle M, Langenbucher A, Kus MM, Rummelt C, Naumann GOH. “Orientation teeth” in non-mechanical laser corneal trephination for penetrating keratoplasty: 2.94 μm Er:YAGv 193 nm ArF excimer laser. Br J Ophthalmol. 1999;83:1008–12.
Seitz B, Langenbucher A, Kus MM, Küchle M, Naumann GOH. Nonmechanical corneal trephination with the excimer laser improves outcome after penetrating keratoplasty. Ophthalmology. 1999;106:1156–65.
Seitz B, Langenbucher A, Naumann GOH. Trephination in penetrating keratoplasty. In: Reinhard T, Larkin F, editors. Essentials in ophthalmology - corneal and external eye disease. Berlin: Springer; 2006. p. 123–52.
Lang GK, Naumann GOH, Koch JW. A new elliptical excision for corneal transplantation using an excimer laser. Arch Ophthalmol. 1990;108:914–5.
Seitz B, Hager T, Langenbucher A, Naumann GOH. Reconsidering sequential double running suture removal after penetrating keratoplasty – a prospective randomized study comparing excimer laser and motor trephination. Cornea. 2018;37:301–6.
Seitz B, Langenbucher A, Nguyen NX, Kus MM, Küchle M, Naumann GOH. Results of the first 1000 consecutive elective nonmechanical keratoplasties with the excimer laser - a prospective study over more than 12 years. Ophthalmologe. 2004;101:478–88.
Szentmáry N, Langenbucher A, Naumann GOH, Seitz B. Intra-individual variability of penetrating keratoplasty outcome after excimer laser versus motorized corneal trephination. J Refract Surg. 2006;22:804–10.
Tóth G, Szentmáry N, Langenbucher A, Akhmedova E, El-Husseiny M, Seitz B. Comparison of excimer laser versus femtosecond laser assisted trephination in penetrating keratoplasty: a retrospective study. Adv Ther. 2019;36:3471–4382.
Flockerzi E, Maier P, Böhringer D, Reinshagen H, Kruse F, Cursiefen C, Reinhard T, Geerling G, Torun N, Seitz B. Trends in corneal transplantation from 2001 to 2016 in Germany: a report of the DOG-Section cornea and its keratoplasty registry. Am J Ophthalmol. 2018;188:91–8.
Cursiefen C, Schaub F, Bachmann B. Update: deep anterior lamellar keratoplasty (DALK) for keratoconus. Ophthalmologe. 2016;113:204–12.
Schaub F, Heindl LM, Enders P, Roters S, Bachmann BO, Cursiefen C. Deep anterior lamellar keratoplasty. Experiences and results of the first 100 consecutive DALK from the university eye hospital of cologne. Opthalmology. 2017;114:1019–26.
Seitz B, Cursiefen C, El Husseiny M, Viestenz A, Langenbucher A, Szentmary N. DALK and penetrating laser keratoplasty for advanced keratoconus. Ophthalmologe. 2013;110:839–48.
Holbach LM, Asano N, Naumann GO. Infection of the corneal endothelium in herpes simplex keratitis. Am J Ophthalmol. 1998;26:592–4.
Daas L, Hamon L, Ardjomand N, Safi T, Seitz B. Excimer laser-assisted DALK: a case report from the Homburg Keratoconus Center (HKC). Ophthalmologe. 2021;118:1245–8.
Anwar M, Teichmann KD. Big-bubble technique to bare Descemet’s membrane in anterior lamellar keratoplasty. J Cataract Refract Surg. 2002;28:398–403.
Cursiefen C, Heindl LM. Perspectives of deep anterior lamellar keratoplasty. Ophthalmologe. 2011;108:833–9.
Seitz B, Daas L, Flockerzi E, Suffo S. Descemet membrane endothelial keratoplasty DMEK - donor and recipient step by step. Ophthalmologe. 2020;117:811–28.
Reinhart WJ, Musch DC, Jacobs DS, Lee WB, Kaufman SC, Shtein RM. Deep anterior lamellar keratoplasty as an alternative to penetrating keratoplasty: a report by the American Academy of Ophthalmology. Ophthalmology. 2011;118:209–18.
Cheng YYY, Visser N, Schouten JS, Wijdh RJ, Pels E, Cleynenbreugel H, Eggink CA, Zaal MJW, Rijneveld WJ, Nuijts RMMA. Endothelial cell loss and visual outcome of deep anterior lamellar keratoplasty versus penetrating keratoplasty: a randomized multicenter clinical trial. Ophthalmology. 2011;118:302–9.
Hos D, Matthaei M, Bock F, Maruyama K, Notara M, Clahsen T, Hou Y, Le VNH, Salabarria AC, Horstmann J, Bachmann BO, Cursiefen C. Immune reactions after modern lamellar (DALK, DSAEK, DMEK) versus conventional penetrating corneal transplantation. Prog Retin Eye Res. 2019;73:100768.
Myerscough J, Friehmann A, Bovone C, Mimouni M, Busin M. Evaluation of the risk factors associated with conversion of intended deep anterior lamellar keratoplasty to penetrating keratoplasty. Br J Ophthalmol. 2020;104:764–7.
Dua HS, Faraj LA, Said DG, Gray T, Lowe J. Human corneal anatomy redefined: a novel pre-Descemet’s layer (Dua’s layer). Ophthalmology. 2013;120:1778–85.
Sarnicola E, Sarnicola C, Cheung AY, Holland EJ, Sarnicola V. Surgical corneal anatomy in deep anterior lamellar keratoplasty: suggestion of new acronyms. Cornea. 2019;38:515–22.
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Daas, L., Hamon, L., Flockerzi, E., Suffo, S., Seitz, B. (2023). Excimer Laser-Assisted Keratoplasty: Penetrating Keratoplasty “Excimer-PKP” and Deep Anterior Lamellar Keratoplasty “Excimer-DALK”. In: Alió, J.L., del Barrio, J.L.A. (eds) Modern Keratoplasty. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-031-32408-6_11
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