Types of Keratoplasties

In this section, we will discuss about the types of keratoplasties. Opitcal keratoplasty is done for visual rehabilitation. A penetrating keratoplasty, as shown in the video, is the most common type. Here the replacement of a full-thickness visual axis scar, or opacity, by a full-thickness donor graft is seen.

Therapeutic keratoplasty is performed for treatment of an underlying disease such as an infection. This could be in the form of a therapeutic penetrating keratoplasty as seen in the video where we see keratoplasty being performed for control of infection in the case of an extensive infected corneal ulcer. This could also be in the form of a therapeutic anterior lamellar keratoplasty, which may be performed for control of localized anterior infections.

Tectonic keratoplasty is performed to increase corneal strength. For example, crescentic lamellar keratoplasty may be performed for peripheral ulcerative keratitis. In penetrating keratoplasty, all the layers of the host cornea are replaced with a full-thickness donor graft. In lamellar keratoplasty, only a part of the donor cornea is transplanted instead of a full-thickness graft. This video shows an anterior lamellar keratoplasty being performed.

The anterior layers of the cornea up to the host pre-Descemet’s membrane are removed. And the Descemet’s membrane is stripped from a donor cornea. The donor cornea is then punched to the desired size, and the graft is sutured onto the host bed.