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Cornea. 2001 Nov;20(8):885-7.

A new surgical technique for keratoglobus-tectonic lamellar keratoplasty followed by secondary penetrating keratoplasty.

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Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK.



To develop a technique that achieves satisfactory visual rehabilitation in keratoglobus, without the problems of re-epithelialization failure and with minimal risk of graft rejection.


A patient with bilateral keratoglobus and visual acuities of light perception in the right eye and 6/60 in the left underwent a tectonic lamellar keratoplasty to the right eye. The cornea was first trephined to the depth of the anterior stroma within the limbus. A lamellar dissection technique then was used to tunnel into sclera under the limbus to preserve stem cells. The host corneal epithelium was completely d├ębrided, and a donor corneoscleral button, denuded of its endothelium, was laid on top. A paracentesis was made, and aqueous was aspirated until the anterior chamber had collapsed enough to take up a more physiologic shape. The donor corneoscleral graft was sutured into the prefashioned scleral bed with long, interrupted sutures. Once in situ, the donor graft was d├ębrided of epithelium, and the host limbus was sutured on to it, covering its scleral component. Six months later, a penetrating keratoplasty was performed. The same procedure was performed on the left eye 2 years later.


The right eye maintained a best-corrected visual acuity of 6/60 for 16 months after the penetrating graft until the graft decompensated, leaving a final acuity of counting fingers. The left eye maintained a best-corrected visual acuity of 6/18.


Tectonic lamellar keratoplasty to preserve the host limbus, followed by secondary penetrating keratoplasty, is a realistic alternative to other procedures for the surgical management of keratoglobus.

[Indexed for MEDLINE]

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