Fibrin glue effective in total anterior lamellar keratoplasty

Lisbon, Portugal-The use of fibrin glue seems to be effective and safe in total anterior lamellar keratoplasty (TALK), a procedure that completely exposes Descemet's membrane within the area of host corneal trephination. Thomas John, MD, explained the procedure, which involves the transplantation of donor cornea without Descemet's membrane and endothelium, at the European Society of Cataract and Refractive Surgeons annual meeting.

Ten patients (six women, four men; average age, 48 years) underwent this procedure. Seven patients had keratoconus diagnosed; they were unable to wear contact lenses and required surgical intervention. Three patients had corneal scarring and the symptoms included blurred vision, glare, and corneal scarring in the visual axis.

Because of the severity of the cases, i.e., the extreme thinning of the cornea, the automated lamellar technique was not considered an option and manual TALK was performed in all cases, said Dr. John, associate professor of ophthalmology, Loyola University at Chicago, Maywood, IL.

He demonstrated how TALK is performed on a patient with keratoconus. In this procedure a Hanna trephine is used and set to about 300 to 350 µm depending on the preoperative pachymetry value.

The first layer of the corneal stroma is removed and the cornea is hydrated. The cornea is stained with indocyanine green (ICG) stain; trypan blue can also be used to lower the cost of the procedure, he explained. The procedure then proceeds with peeling of additional stromal layers.

"With peeling, the clearer deeper layers of the stroma are revealed," Dr. John explained. "The staining with either ICG or trypan blue is limited to the area of stromal exposure, which is advantageous for dissection."

He warned that when performing TALK on younger patients, they are more prone to tears in Descemet's membrane or perforation as the depth of the stromal peeling increases.

"A trick that can be used is to lift and cut so that there is no contact with Descemet's membrane. Contact may lead to micro- or macro-perforations," he emphasized.