Automated Lamellar ThermoKeratoplasty

ALTK is gaining greater importance in recent years for correcting several types of corneal disorders. It is considered an effective alternative among the ThermoKeratoplasty(TK) surgical procedures when serious medical interventions are required in managing post LASIK complications, postkeratoplasty astigmatism, high degrees of myopia( usually for -5.00 to -30.00 D) and sometimes in cases of moderate to mild Hyperopia (e.g. Hyperopic Automated Lamellar keratoplasty or H-ALK).

Automated Lamellar Keratoplasty (ALK) is an all-new approach of refractive error correction that uses a lamellar grafting technique. Here, the anterior corneal surface of the host eye is cut precisely and the donor lamellar grafting is done. In the myopic condition, the center of the eye (optical zone) is made flatter by removing a portion of the tissues from the surface layer while for hyperopic patients, the corneal surface is curved upwards and made steeper to control farsightedness. Then, the host corneal flap is replaced just like any LASIK procedure. The operation time as well as the healing process is observed to be less time consuming and the visual outcomes are better than that of the traditional Penetrating Keratoplasty (PK) procedures and LASIK. But past clinical evidences confirm that post- ALTK Treatment may result in some potential risks such as allograft rejections, donor stromal rejection and intraocular complications. These, in turn, may lead to unstable post-operative visual outcomes such as unstable visual acuity and even an irreversible loss of vision. Nevertheless, the risk of endothelial rejection by lamellar grafting can be controlled to a significant extent. ALTK has been performed on a limited number of patients until recently. Due to the scarcity of clinical statistics, facts pertaining to the standards of examination and outcomes of this surgical procedure, we can not arrive at any robust conclusion on whether ALTK is advantageous over other similar refractive surgeries in determining efficacy and stability of vision correction.

In general, Automated Lamellar Keratoplasty (ALK) is relatively comfortable, has a smaller recovery period and stabilization of vision. The outcome is not as predictable as that of LASIK, LASEK or other similar treatments. In most cases, it is observed that patients receiving Automated Lamellar Keratoplasty may experience complications such as:

·    Increased risk of having an irregular astigmatism

·    Corneal scarring

·    Higher incidence of glare

·    Over correction or under correction

·    Greater risk of corneal infections

·    Loss of vision