Lamellar keratectomy is a specialized eye surgery that focuses on the cornea, the clear, outermost layer at the front of the eye. This procedure involves the precise removal or reshaping of a partial thickness of corneal tissue. It is performed to address various conditions affecting the cornea, aiming to improve vision or alleviate discomfort. The technique allows for targeted treatment while preserving the deeper, healthy structures of the eye.
Understanding Lamellar Keratectomy
Lamellar keratectomy involves the surgical removal or reshaping of specific layers of the cornea, rather than the entire corneal thickness. The cornea is comprised of five distinct layers: the superficial epithelium, Bowman’s layer, the thick stroma, Descemet’s membrane, and the innermost endothelium. This procedure specifically targets the anterior layers, typically the epithelium and a portion of the stroma, leaving the deeper, healthy layers intact.
The fundamental principle behind lamellar keratectomy is to remove diseased or damaged tissue from the outer corneal layers while preserving the structural integrity and optical clarity of the deeper cornea. This approach minimizes the risk of complications associated with full-thickness corneal procedures, which involve penetrating the entire cornea. By focusing on partial thickness, the eye’s internal environment remains undisturbed, contributing to a more controlled recovery.
Conditions Treated by Lamellar Keratectomy
Lamellar keratectomy serves as a treatment for a range of corneal conditions that primarily affect the anterior layers of the eye. This includes the removal of superficial corneal scars resulting from trauma, infection, or previous surgeries, which can obstruct light entry and blur vision. It is also used to manage certain types of corneal dystrophies, such as anterior basement membrane dystrophy (ABMD) or granular dystrophy, where abnormal deposits accumulate in the superficial cornea.
The procedure is also effective for treating recurrent corneal erosions, a condition where the outermost layer of the cornea repeatedly peels away, causing pain and blurry vision. In some cases, superficial corneal tumors or growths that are confined to the anterior layers can be precisely removed using this technique.
How Lamellar Keratectomy is Performed
Performing a lamellar keratectomy requires meticulous surgical precision to ensure only the affected corneal layers are removed. The procedure typically begins with the application of local anesthesia to numb the eye, and a speculum is used to keep the eyelids open. The surgeon then carefully delineates the area of the cornea to be treated, often using a surgical marker.
The removal of the diseased tissue can be accomplished through various techniques. In some cases, manual dissection is employed, where the surgeon uses specialized micro-surgical instruments, such as a blade or spatula, to carefully peel away or shave the superficial layers of the cornea. For more precise or extensive removals, instruments like a microkeratome, which is a motorized oscillating blade, or a femtosecond laser may be utilized to create an extremely accurate and uniform cut at a predetermined depth. These advanced tools allow for the creation of a smooth corneal surface, which is important for optimal visual outcomes.
What to Expect After Lamellar Keratectomy
Following a lamellar keratectomy, patients typically experience a recovery period that involves some discomfort and changes in vision. Immediately after surgery, common sensations can include mild to moderate pain, light sensitivity, and a feeling of foreign body sensation, which usually subsides within a few days. Blurry vision is also expected in the initial post-operative phase, as the cornea heals and reshapes.
Patients are usually prescribed a regimen of eye drops, including antibiotics to prevent infection and anti-inflammatory medications to manage swelling and discomfort. Protective eyewear, such as a shield or glasses, may be recommended to safeguard the healing eye. Follow-up appointments with the surgeon are scheduled to monitor the healing progress and adjust medication as needed. While significant vision improvement can be noticed within weeks, the final visual outcome may take several months to stabilize as the cornea fully remodels. Potential, though infrequent, risks include infection, corneal haze, or irregular astigmatism, which can sometimes impact visual clarity.