Palevski Dahlia, Marom Noa Reinhertz, Livny Eitan, Nahum Yoav, Levinger Samuel, Bahar Irit
Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel.
Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Am J Ophthalmol Case Rep. 2025 Jul 28;39:102406. doi: 10.1016/j.ajoc.2025.102406. eCollection 2025 Sep.
To describe a modified technique utilizing femtosecond laser-assisted penetrating keratoplasty for the surgical management of keratoglobus with an extremely thin peripheral cornea.
Two eyes of two patients with advanced keratoglobus underwent a modified, donor-only, top hat keratoplasty. Femtosecond laser-assisted top hat configuration was exclusively performed on the donor cornea (half top hat) and sutured under the recipient's cornea which underwent a regular full thickness trephination. Patients were followed up for 12-24 months after intervention. Visual acuity and anatomical results (measured using corneal tomography and anterior segment OCT) were evaluated after this intervention.
Post-operatively, best corrected visual acuity improved from counting fingers in the first patient and 20/720 in the second to 20/30 in both. Keratometry values markedly decreased, and peripheral thickness was augmented in both cases. No complications during the follow-up period were noted.
Top hat configuration keratoplasty on donor cornea alone may be a unique surgical solution enabling the augmentation of the peripheral cornea in keratoglobus eyes, providing good visual outcomes as well as structural integrity.
描述一种改良技术，利用飞秒激光辅助穿透性角膜移植术治疗周边角膜极薄的球形角膜病。
对两名晚期球形角膜病患者的两只眼睛进行了改良的仅供体“顶帽”角膜移植术。飞秒激光辅助的顶帽构型仅在供体角膜上进行（半顶帽），并缝合在接受常规全层环钻术的受体角膜下方。干预后对患者进行了12至24个月的随访。干预后评估视力和解剖学结果（使用角膜地形图和眼前节光学相干断层扫描测量）。
术后，第一位患者的最佳矫正视力从数指提高到第二位患者的20/30，第二位患者从20/720提高到20/30。两个病例的角膜曲率值均明显降低，周边厚度增加。随访期间未发现并发症。
仅在供体角膜上进行顶帽构型角膜移植术可能是一种独特的手术解决方案，能够增加球形角膜病患者的周边角膜厚度，提供良好的视力结果以及结构完整性。
