| Penetrating keratoplasty procedures |
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| Limbus-limbus donor grafts |
Avoids graft–host junction at thinned mid-periphery |
Loss of immune privilege,
Limbal stem cell disruption,
Angle structure disruption |
| |
| Lamellar keratoplasty procedures |
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|
| Epikeratoplasty |
Easy to perform,
Good tectonic stability,
Corneal flattening effect,
Reduced myopia and astigmatism |
Limbal stem cell disruption,
Persistent epithelial defect |
| Epikeratoplasty with 360 host peripheral intrastromal pocket for peripheral donor lenticule |
No limbal stem cell disruption,
No angle structure disruption,
Provides stable host bed for possible secondary penetrating keratoplasty |
Interface opacities and intraepithelial cysts |
| Epikeratoplasty followed by secondary penetrating keratoplasty |
Visual rehabilitation following host bed stabilisation by epikeratoplasty |
2-stage procedure |
| ‘Tuck-in' lamellar keratoplasty |
Good tectonic stability,
No limbal stem cell disruption,
No angle structure disruption |
Technically difficult,
Interface opacities |
| Pentacam-based deep anterior lamellar keratoplasty |
3D topographical analysis preoperatively,
Decreased endothelial rejection rate |
Technically demanding |
| Corneoscleral rim |
Easy to perform,
Buttress over thinned corneal periphery for tectonic stability
Slowed progression of mid-peripheral thinning
Allows for delay in further surgical intervention
Decreased immune reaction |
Temporary measure |
