65710 Keratoplasty (corneal transplant); anterior lamellar

Name of the Procedure:

Keratoplasty (corneal transplant); anterior lamellar, often referred to as Anterior Lamellar Keratoplasty (ALK) or Lamellar Corneal Transplant.

Summary

This is a surgical procedure that involves the partial transplantation of the cornea. In an Anterior Lamellar Keratoplasty, only the front layers of the cornea are replaced, preserving the healthy posterior layers.

Purpose

This procedure addresses issues such as corneal scars, thinning, or swelling that affect the front layers of the cornea. The goal is to restore vision by replacing damaged corneal tissues with healthy donor tissue.

Indications

• Corneal dystrophies affecting the anterior layers
• Superficial corneal scarring or opacities
• Keratoconus not responding to other treatments
• Recurrent corneal erosions

Patients with healthy endothelial (innermost) layers of the cornea are particularly suitable for this procedure.

Preparation

• Patients may be advised to fast for a specific period before the surgery.
• Medications may need to be adjusted, especially blood thinners.
• Preoperative diagnostic tests like corneal topography and pachymetry to assess the cornea's shape and thickness.
• Arranging for post-procedure transportation and assistance at home.

Procedure Description

1. The patient is placed under local anesthesia with sedation or general anesthesia.
2. A precise incision is made to remove the anterior layers of the cornea.
3. Healthy donor tissue, prepared to match the removed tissue, is carefully placed.
4. The donor tissue is then sutured into place or secured with specialized medical adhesives.
5. Protective measures like a bandage contact lens may be applied post-surgery.

Specialized surgical instruments and microscopes are used to ensure precision.

Duration

The procedure typically takes between 1 to 2 hours.

Setting

Performed in an outpatient surgical center or hospital operating room.

Personnel

• Ophthalmic surgeon
• Surgical nursing team
• Anesthesiologist or nurse anesthetist

Risks and Complications

• Infection
• Graft rejection or failure
• Increased intraocular pressure
• Astigmatism
• Scarring at the graft interface Complications are managed with medications or additional surgical interventions if necessary.

Benefits

• Restoration or significant improvement in vision
• Enhanced corneal transparency
• Lower risk of rejection compared to full-thickness corneal transplants Improvements are usually noticed within a few weeks to months after surgery.

Recovery

• Use of prescribed eye drops to prevent infection and control inflammation
• Avoiding strenuous activities and protecting the eye from trauma
• Regular follow-up appointments to monitor healing and detect early signs of complications
• Full recovery can take several months, with visual stabilization occurring gradually.

Alternatives

• Phototherapeutic keratectomy (PTK) for superficial corneal problems
• Full-thickness corneal transplant (Penetrating Keratoplasty) for deeper corneal issues
• Corneal cross-linking for early-stage keratoconus Each alternative has its own set of benefits, risks, and recovery times.

Patient Experience

Patients may experience mild discomfort or irritation post-surgery, managed with pain medication and eye drops. Visual improvement may be gradual, and protective eyewear is recommended during the initial recovery period for comfort and safety. Regular follow-up visits are crucial for ensuring a successful outcome.