Abstract

DO.02.12

Corneal trephination – How relevant are the new techniques for the patient?

Schmitz K.
Universitäts-Augenklinik Düsseldorf

After more than on hundred years history of keratoplasty, numerous new technical approaches to trephination of donor buttons and recipient bed have been introduced in the recent past.
Until about 1990, only rotating mechanical trephines were used in penetrating keratoplasty. New approaches utilize lasers to achieve a non-mechanical trephination without tissue compression (excimer laser, femtosecond laser). On the other hand, different guided trephine systems have become commercially available that allow a better trephination geometry and trephination of both donor button and recipient bed from the epithelial side. These advances may result in a better and more reproducible reconstitution of the corneal geometry after keratoplasty, warranting lower postoperative astigmatism and better visual outcome. Also the risk of postoperative immune reactions may be decreased because of the smaller wound surface.
At the same time, trephination techniques for lamellar keratoplasty have been widely refined in recent years allowing this tissue sparing approach a wider range of applications in various indications for keratoplasty. A whole scope of techniques for deep anterior lamellar keratoplasty and selective posterior endothelial keratoplasty has been described. The smaller amount of transplanted tissue volume may have positive impact on the incidence of immune reactions and the intraoperatively at least partially maintained mechanical integrity of the cornea may positively influence postoperative astigmatism. The practical advantages of the lamellar techniques for the patient on the long run are still unclear and need longer follow up since potential interface problems between the corneal layers may cause a decreased transparency and thus limit the visual outcome.

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