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ARSLANS COVERED CORNEA TECHNIQUE A NEW
TECHNIQUE IN PENETRATING KERATOPLASTY
Arslan Osman S., Toker Mustafa I., Gürsoy H.
Hüseyin, Özkök Ahmet, Arici Ceyhun
Department of Ophthalmology, Istanbul
University, Cerrahpasa Medical School,
Istanbul/TURKEY. Department of Ophthalmology,
Cumhuriyet University Medical School,
Sivas/TURKEY.
Purpose To present a new keratoplasty technique
lowering the risk of complications such as
expulsive hemorrhage, vitreus loss, spontaneous
lens expulsion in high-risk patients having
especially high risk of expulsive hemorrhage with
the open-sky technique.
While the recipient beds are prepared, after
30-45 degrees cuttings, Arslans closed technique
was applied by a quadrant is sutured. By this
way, recipient bed had been completely
trepanized therefore, the recipient corneal
buttons were left its own location by the
sutures. Endothelium of the donor corneas which
were cut 0.75-1.00 mm bigger than the recipient
bed were covered with a cohesive viscoelastic,
then the donor grafts were sutured to 240 degrees
quadrant of the recipient beds with 10/0
separated sutures. The recipient corneal buttons
were removed by cutting the sutures and sliding
under the donor graft from 120 degrees open
quadrant of the wound. Then preparing sutures on
the donor graft were tied rapidly, thus the
anterior chamber and the glob were stabilized
(Arslans covered cornea technique).
There were bilateral sclerocornea, cornea plana
and aniridia in a new born baby. Because of
amblyopia risk, there was an immediate
keratoplasty indication to open the optic axis.
The recipient bed was prepared with Arslans
closed cornea technique by cutting and suturing
the recipient cornea quadrant by quadrant without
creating open-sky conditions. The cutted
recipient corneal button was stayed in its own
place with the sutures.
The Donor corneal button was prepared as 0.5-1.0
mm larger than the recipient bed. Both the
recipient corneal epithelial and the donor
corneal endothelial surfaces were covered with
thick cohesive viscoelastic layers. The purpose
of this process was to save the donor endothelium
from the mechanical trauma.
Methods In infants and children, while
penetrating keratoplasty application in
traumatized eyes, the risks of protrusion of
iris-lens diagram, vitreus expansion and
choroidal hemorrhage are quite high during
trepanization of cornea and this condition is
more important in one-eyed patients. Thus, 7 eyes
of 3 infants and 4 adults totally 7 high risk
patients were undergone penetrating keratoplasty
with Arslans covered cornea technique.
Preoperative diagnoses were Peters anomaly (2),
congenital scleroderma (1), chemical burn (2),
traumatized eye (1), and regraft in traumatized
eye (1).
Results The technique were completed without
vitreus loss or more heavy complications in all
the patients. Postoperatively, the donor failure
was not seen due to the endothelial loss or any
other reasons, and the significant edema of the
donor was not occurred.
In the end stage, the remaining sutures were
applied under the safe condition of the closed
surgery.
The donor graft was sutured to the recipient bed
over the recipient cornea. In a quadrant, a
120-140 degree part of the wound was left without
suture, and a confidence suture was applied there
without tying. The recipient corneal button was
detached by cutting the sutures attaching the
recipient cornea to the recipient bed. The
recipient corneal button was removed by sliding
underneath the donor graft, and the confidence
suture was tied. Thus, the donor graft had been
placed to the recipient bed without exposing
open-sky conditions.
Conclusion In the patient having the risk of
vitreus and lens loss or expulsive hemorrhage,
Arslans covered cornea technique is a safe and
effective method to minimalize the risks related
to surgery.