A Case of Anterior Synechiolysis with Lamellar Corneal Dissection in Penetrating Keratoplasty

Yoon Mi Sung; Eun Chul Kim

doi:10.3341/jkos.2014.55.9.1388

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Sung and Kim: A Case of Anterior Synechiolysis with Lamellar Corneal Dissection in Penetrating Keratoplasty

Case Report

J Korean Ophthalmol Soc 2014;55(9):1388-1391.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.9.1388

A Case of Anterior Synechiolysis with Lamellar Corneal Dissection in Penetrating Keratoplasty

Yoon Mi Sung, MD, Eun Chul Kim, MD, PhD

Department of Ophthalmology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea

Address reprint requests to Eun Chul Kim, MD, PhD, Department of Ophthalmology, The Catholic University of Korea, Bucheon St. Mary's Hospital, #327 Sosa-ro, Wonmi-gu, Bucheon 420-717, Korea, Tel: 82-32-340-2125, Fax: 82-32-340-2544, E-mail: eunchol@hanmail.net

Received 26 April 2014 Revised 25 July 2014 Accepted 1 August 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of anterior synechiolysis with lamellar corneal dissection in penetrating keratoplasty.

Case summary

In an eye with graft failure and anterior synechiae, we performed anterior synechiolysis with a healon needle after lamellar dissection using vacuum trephine to visualize the anterior chamber during penetrating keratoplasty. Additionally, the remnant corneal layer was removed using corneal scissors. A donor cornea was harvested using a vacuum trephine and the corneal button was sewn in place with 10-0 nylon. We observed a well grafted cornea and well formed anterior chamber with no anterior synechiae observed on follow-up.

Conclusions

In patients with anterior synechiae, the cornea can be dissected from the anterior synechiae completely using lamellar corneal dissection in penetrating keratoplasty to visualize the anterior chamber.

Keywords: Anterior synechiae, Lamellar corneal dissection, Penetrating keratoplasty, Synechiolysis

References

1. Chen WL, Hu FR, Wang IJ. Changing indications for penetrating keratoplasty in taiwan from 1987 to 1999. Cornea. 2001; 20:141–4.

2. Wilson SE, Kaufman HE. Graft failure after penetrating keratoplasty. Surv Ophthalmol. 1990; 34:325–56.

3. Castroviejo R. Surgical treatment of anterior synechiae before and after keratoplasty. Arch Ophthalmol. 1964; 72:240–5.

4. Stallard HB, Roper-Hall MJ. Stallard's eye surgery. 6th ed.Bristol [Eng.]: John Wiley & Sons;1980. p. 392–445.

5. Castroviejo R. Atlas of keratectomy and keratoplasty. 1st ed.Philadelphia: WB Saunders;1966. p. 350.

6. Ardjomand N, Fellner P, Moray M, et al. Lamellar corneal dissection for visualization of the anterior chamber before triple procedure. Eye (Lond). 2007; 21:1151–4.

Figure 1.

(A) Host cornea before surgery. (B) Corneal endothelium microscopy before surgery (the figure 3225 in the result was miscounted). (C) Anterior segment photography on 1 month postoperatively. (D) Well formed anterior chamber after surgery on 1 month postoperatively.

Figure 2.

(A) Initial cut on the host cornea using vacuum trephine. (B) Cross-sectional view of (A). (C) Lamellar dissection using beaver blade. (D) Cross-sectional view after lamellar dissection. (E) Anterior synechiolysis using healon needle. (F) Cross-sectional view of (E).

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