Emerging PKP technologies: Alphabet soup of corneal surgery

The future of penetrating keratoplasty (PKP) may be "a lot more work, but no more money" as Michael Belin, MD, of the United States jokingly described it Monday, but the number of PKP procedures are definitely presenting options for the corneal surgeon.

Dr. Belin provided an overview of the new PKP procedures in his presentation, "PKP: Emerging Technologies" at the World Ophthalmology Congress. He outlined each procedure - listing the advantages, disadvantages and what each procedure brings to the table for corneal PKP.

He pointed out that all corneal surgeons are familiar with PKP. The procedure has a rapid surgical time (less than 1 hour). The requirements are minimal. There is little equipment and no optical interface. It has a long, successful track record. It also has a number of disadvantages. The biggest is that PKP is an open-eye procedure and it has long period of rehabilitation with unpredictable outcomes.

"Leave it up to us to take something that was simple and apply modern technology, modern techniques, and make something that is more complicated, takes longer, pays less," added Dr. Belin. "That's the price you pay for progress."

Dr. Belin reviewed each of the newer PKP techniques. "Unfortunately, what we have is the alphabet soup of corneal surgery," he said. Basically, technology has taken a "full-thickness procedure" and broken it down to different layers.

Automated lamellar therapeutic keratoplasty (ALTK) is the same as lamellar keratoplasty, but the procedure is now done with a microkeratome. He cited both the advantages and disadvantages of the procedure.

He then outlined the advantages of endothelial lamellar keratoplasty (ELK) and deep lamellar endothelial keratoplasty (DLEK). ELK has fallen among surgeons because the results of the procedure have been disappointing. The key to DLEK is the preparation of the host and preparation of the donor lenticle. Dr. Belin described the procedure in detail, outlining the advantages and disadvantages, as well as potential complications.

He also discussed descemets stripping endothelial keratoplasty (DSEK) and synthetic keratoprosthesis, including the Alpha-Cor procedure.