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Advancements in Anterior Lamellar Keratoplasty

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Advances in Medical and Surgical Cornea

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

Abstract

Anterior lamellar keratoplasty (ALK) is a corneal transplant procedure where diseased anterior corneal stroma is selectively replaced with donor stromal tissue while preserving the host Descemet’s membrane and endothelium. Despite ALK’s longer history, the most commonly performed procedure for the last 100 years has been PKP, and this has been attributed to the technical difficulties in achieving a successful ALK. However, over the past two decades, improvements in surgical instrumentation and techniques, including the femtosecond laser, have caused resurgence in interest in anterior lamellar corneal surgery.

ALK can be subcategorized as superficial anterior lamellar keratoplasty (sALK), for the treatment of stromal pathology usually involving the anterior 200–250 μm, and deep anterior lamellar keratoplasty (DALK) for the treatment of deeper stromal pathology. The most common techniques for performing each are described in this chapter. For sALK we discuss in detail manual dissection, microkeratome-assisted ALK, and sutureless femtosecond laser-assisted anterior lamellar keratoplasty (FALK) with emphasis on steps in performing the procedures, complications, and outcomes. Similarly, we describe common DALK procedures with extra focus on manual dissection (open dissection), Melles technique (closed dissection), Anwar’s big-bubble technique, and femtosecond laser-assisted techniques. Finally general considerations and possible complications are described with insight on management options and follow-up care.

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Conflict of Interest

Marwan Atallah and Guillermo Amescua declare that they have no conflict of interest.

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No human studies were carried out by the authors for this article.

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No animal studies were carried out by the authors for this article.

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Authors and Affiliations

  1. Department of Ophthalmology, University of Miami—Bascom Palmer Eye Institute, Miami, FL, USA

    Marwan Atallah MD & Guillermo Amescua MD

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  1. Marwan Atallah MD
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  2. Guillermo Amescua MD
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Correspondence to Guillermo Amescua MD .

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Editors and Affiliations

  1. Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA

    Bennie H. Jeng

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© 2014 Springer-Verlag Berlin Heidelberg

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Atallah, M., Amescua, G. (2014). Advancements in Anterior Lamellar Keratoplasty. In: Jeng, B. (eds) Advances in Medical and Surgical Cornea. Essentials in Ophthalmology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-44888-5_7

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  • DOI: https://doi.org/10.1007/978-3-662-44888-5_7

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-44887-8

  • Online ISBN: 978-3-662-44888-5

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