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    Strategies for surgical intervention aid in peripheral corneal disease

    C- or banana-shaped grafts can help maintain corneal integrity and contour

     

    “The goal in these cases is to preserve or restore visual function,” he said. “To do so, topographic changes and irregular astigmatism must also be addressed over the long term.”

    Though not much information is in the literature concerning tectonic keratoplasty, it has been Dr. Tan’s experience that tectonic grafts do well. However, complications can include active keratitis, postoperative melt, and inflammation.

    “The graft survival rate is about 50% [at] 5 years postoperatively after penetrating keratoplasty,” he said. “Lamellar keratoplasty has slightly better outcomes.”

    Various approaches to tectonic keratoplasty include using small-patch grafts, mushroom grafts, or onlay of anterior lamellar grafts to correct peripheral corneal disorders. A tuck-in lamellar keratoplasty can be performed to treat peripheral ectasias.

    Match-and-patch grafts

    Dr. Tan described his approach as “match-and-patch peripheral grafts” that are C-shaped to avoid the central cornea.

    “The idea is to have banana-shaped grafts that are essentially anterior lamellar patch grafts shaped to restore integrity of the peripheral melting area,” he said. “The advantages are prevention of endothelial rejection and minimization of intraocular surgery and complications, as well as maintenance of the spherical corneal shape.”

    In addition, the procedure can be performed in the presence of a small- or moderate-sized perforation, he explained. This provides tectonic reconstruction of the peripheral corneal anatomy without replacing the central cornea.

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