ISSN 2398-2977      

Cornea: posterior lamellar keratoplasty

pequis
Contributor(s):

Tim Knott

Johana Premont

Synonym(s): PLK, Keratoplasty


Introduction

  • Creation of an anterior flap of healthy stroma to remove a deep stromal lesion, anywhere in the cornea. Homologous donor tissue is grafted within the defect.
  • To provide tectonic, structural support to a deeper corneal defect.

Uses

  • Indicated for removal of deep stromal lesions <10 mm diameter anywhere in the cornea, with healthy overlying stroma, such as stromal abscess Link: Cornea stromal abscess.
  • Decreased surgical, anesthetic and healing time.
  • Donor tissue (homologous cornea or amniotic membrane) can be transplanted within the created defect to provide additional structural support.

Advantages

  • Deep stromal corneal lesion can be removed while preserving the healthy overlying anterior corneal stroma.
  • Minimizes anesthesia and surgical time compared to penetrating keratoplasty.
  • Good tectonic support.

Disadvantages

  • Indicated for deep stromal corneal disease only.
  • More technically challenging than corneo-conjunctival transposition.
  • Requires use of homologous donor tissue (usually frozen) which results in greater corneal scarring and increased graft rejection.
  • Requires penetration of the anterior chamber.

Requirements

This article is available in full to registered subscribers

Sign up now to obtain ten tokens to view any ten Vetlexicon articles, images, sounds or videos, or Login

Preparation

This article is available in full to registered subscribers

Sign up now to obtain ten tokens to view any ten Vetlexicon articles, images, sounds or videos, or Login

Procedure

This article is available in full to registered subscribers

Sign up now to obtain ten tokens to view any ten Vetlexicon articles, images, sounds or videos, or Login

Aftercare

This article is available in full to registered subscribers

Sign up now to obtain ten tokens to view any ten Vetlexicon articles, images, sounds or videos, or Login

Outcomes

This article is available in full to registered subscribers

Sign up now to obtain ten tokens to view any ten Vetlexicon articles, images, sounds or videos, or Login

Prognosis

  • If technically correct and the disease process is controlled, the majority of corneal lesions will heal with the above techniques.
  • Scars will form at the ulcer site.
  • Intraocular synechiae   Eye: anterior synechia - post-corneal penetration  may interfere with pupillary movement.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • de Linde Henriksen M et al (2013) Equine deep stromal abscesses (51 cases - 2004-2009) - Part 1: the clinical aspects with attention to the duration of the corneal disease, treatment history, clinical appearance, and microbiology results. Vet Ophthal 17Suppl 1, 6-13 PubMed
  • de Linde Henriksen M et al (2013) Equine deep stromal abscesses (51 cases - 2004-2009) - Part 2: the histopathology and immunohistochemical aspect with attention to the histopathologic diagnosis, vascular response, and infectious agents. Vet Ophthal 17Suppl 1, 14-22 PubMed.
  • Makra Z, Tuboly T & Bodo G (2013) Penetrating keratoplasty and graft rejection in eight horses. Acta Vet Hung 61 (2), 160-174 PubMed.
  • Martins B C et al (2013) Light microscopic evaluation and scanning electron microscopic analysis of horse eyes following deep anterior lamellar keratectomy. Vet Ophthal 16Suppl 1, 42-51 PubMed.
  • Henriksen Mde L et al (2012) Visual outcome after corneal transplantation for corneal perforation and iris prolapse in 37 horses: 1998-2010. Equine Vet J Suppl (43), 115-119 PubMed.
  • Brooks D E (2010) Targeted lamellar keratoplasty in the horse: a paradigm shift in equine corneal transplantation. Equine Vet J Suppl (37), 24-30 PubMed.
  • Plummer C E et al (2009) The use of amniotic membrane transplantation for ocular surface reconstruction: a review and series of 58 equine clinical cases (2002-2008). Vet Ophthal 12Suppl 1, 17-24 PubMed.
  • Brooks D E et al (2008) Corneal transplantation for inflammatory keratopathies in the horse: Visual outcome in 206 cases (1993-2007). Vet Ophthal 11 (2), 123-133 PubMed.
  • Ollivier F J et al (2006) Amniotic membrane transplantation for corneal surface reconstruction after excision of corneolimbal squamous cell carcinomas in nine horses. Vet Ophthal (6), 404-413 PubMed.
  • Brooks D E (2005) Penetrating keratoplasty, deep lamellar endothelial keratoplasty, and posterior lamellar keratoplasty in the horse. Clin Tech Equine Pract (1), 37-49 VetMedResource.
  • Denis H M (2004) Equine corneal surgery and transplantation. Vet Clin North Am Equine Pract 20 (2), 361-380, vi-vii VetMedResource.
  • Andrew S E et al (2000) Posterior lamellar keratoplasty for treatment of deep stromal abscesses in nine horses. Vet Ophthal (2-3), 99-103 PubMed.

Other sources of information

  • Clode A & Matthews A (2011) Diseases and Surgery of the Cornea. In: Equine Ophthalmology. 2nd edn. Ed: Gilger B C. Elsevier Saunders, Maryland Heights, MO. pp 181-266

Can’t find what you’re looking for?

We have an ever growing content library on Vetlexicon so if you ever find we haven't covered something that you need please fill in the form below and let us know!

 
 
 
 

To show you are not a Bot please can you enter the number showing adjacent to this field

 Security code