Microkeratome-assisted superficial anterior lamellar keratoplasty

Microkeratome-assisted superficial anterior lamellar keratoplasty (SALK) is a type of lamellar keratoplasty designed to eliminate superficial corneal opacities (ie, haze postexcimer laser treatment, postinfectious superficial scars of any origin, corneal dystrophies and degenerations with superficial opacities, etc.) while minimizing postoperative refractive error, as well as the time necessary for visual rehabilitation.The procedure includes the following: (1) microkeratome-assisted removal of a superficial lamella from the recipient cornea ("free cap" 160 μm thick and 9.0 mm large); (2) microkeratome-assisted preparation of a donor lamella of the same thickness and diameter from a donor cornea mounted on an artificial anterior chamber; and (3) fixation of the donor graft onto the recipient bed by means of overlay sutures. Alternatively, instead of overlay sutures, in most cases a simple bandage contact lens can be successfully used to keep the graft in place. Sutures or contact lenses may be removed few days after surgery (healing is similar to that experienced by patients after laser in situ keratomileusis), and final refraction is possible within 1 month from surgery.SALK shares the same advantages of other types of lamellar keratoplasty: It is an extraocular procedure, preserves the host endothelium, and therefore postoperative steroidal treatment can be minimized, thus avoiding possible side effects (eg, development of glaucoma and/or cataract). However, several other advantages are unique to SALK: The technique is simple, easy to perform (the learning curve is comparable to that of laser in situ keratomileusis), and can be standardized. Most of all, the time necessary for visual rehabilitation after SALK is much shorter than that usually needed when thicker grafts are transplanted. © 2006 Lippincott Williams & Wilkins, Inc.