Use of a Novel Lamellar Keratoplasty With Pleat Technique to Address the Abnormal White-to-White Diameter in Keratoglobus

Abstract

We have demonstrated a modified anterior lamellar keratoplasty with pleat technique to achieve satisfactory visual rehabilitation in extreme keratoglobus. This pleat technique addresses the fundamental structural problem of a vertically displaced limbus in keratoglobus. We highlight the optical illusion of the white-to-white diameter in keratoglobus. We also recommend the baking analogy of muffin to cupcake as a communication aid when explaining the mechanics of surgery to the patient.

Megalocornea, anterior megalophthalmos, keratoglobus and associated anterior segment disorders: A review

“…Lockington et al demonstrated the use of a pleating technique with LKP that serves to address the keratoglobus configuration, which is characterised by an abnormal WTW diameter and limbal angle orientation. 140 Upon placing four cardinal compression sutures at the corneal periphery and manually dissecting the cornea down to Descemet membrane, a modified mattress suture technique gathers the excess peripheral cornea to form a circumferential pleat. The pleat forms the boundary of the exposed host corneal bed where the donor lamellar graft is then attached.…”

“…The pleat forms the boundary of the exposed host corneal bed where the donor lamellar graft is then attached. 140 With this approach, the graft abuts the compressed pleat, as opposed to being tucked in beneath host tissue with the 'tuck-in' LKP technique. Due to the nature of the compressed pleat, the healing process helps to stabilise the graft-host junction and peripheral cornea.…”

“…Due to the nature of the compressed pleat, the healing process helps to stabilise the graft-host junction and peripheral cornea. 140…”

“…Upon placing four cardinal compression sutures at the corneal periphery and manually dissecting the cornea down to Descemet membrane, a modified mattress suture technique gathers the excess peripheral cornea to form a circumferential pleat. The pleat forms the boundary of the exposed host corneal bed where the donor lamellar graft is then attached 140 . With this approach, the graft abuts the compressed pleat, as opposed to being tucked in beneath host tissue with the ‘tuck‐in’ LKP technique.…”

Keratoglobus: a close entity to megalophthalmos

“…Although our patient presented with features, indicative of megalophthalmos i.e. presence of enlarged corneas, increased axial lengths, iridodonesis and absence of increased IOP (Tsai et al 2005 ), but in view of steep corneal curvatures, abnormal and thin cornea, increased white to white diameter (Lockington and Ramaesh 2015 ), normal intraocular pressure, absence of both miosis and ciliary ring enlargement, a diagnosis of buphthalmos or anterior megalophthalmos was excluded.…”