Surgical Treatment of Bullous Keratopathy: Modern Approaches and Trends

Abstract

According to WHO, corneal pathology is the fourth cause (5.1 %) of blindness among the main causes of significant visual impairment in the world after cataract, glaucoma and macular degeneration. Bullous keratopathy is a serious progressive corneal disease, in which the endothelial lesion plays the main role leading to the chronic corneal edema, reduce of visual acuity, development of pain syndrome, formation of permanent opacities, and various infectious complication, which may result in eye globe loss. Since the second half of 90th XX century various modifications of modern posterior (endothelial) keratoplasty have been introduced in the clinical practice, which were subsequently used widely for the treatment of bullous keratopathy. The introduction of new microkeratomes used in refractive surgery significantly contributed to the development of endothelial keratoplasty microsurgical technique, which enables the high quality, selective replacement of the affected corneal layers in comparison to the manual lamellar keratoplasty techniques. One of the contraindications for endothelial keratoplasty is an irreversible central stromal opacity. In that case, modern technologies and new equipment (particularly femtosecond laser) provide an opportunity to perform the penetrating keratoplasty with a complex-shaped profile and corresponding edges of the graft and its bed. In bullous keratopathy, top-hat keratoplasty represents the pathogenically targeted treatment method that allows transplanting of more endothelial cells with a relatively smaller diameter of graft’s anterior segment. This article reviews the literature on modern surgical treatment of bullous keratopathy.