Onlay Lamellar Keratoplasty

An onlay lamellar tissue was sutured into a prepared annular keratectomy over a de-epithelialized surface of corneal thinning secondary to corneal melt. Initially it was covered by a conjunctival graft that was sutured over the onlay transplant to accelerate re-epithelialization and wound healing. Note the conjunctival graft was retracted. 

  • A type of lamellar keratoplasty that is used to reinforce thinned or ectatic corneas
  • Unlike inlay lamellar keratoplasty, there will be no anterior stromal tissue removed from the recipient cornea

Advantages:

  • Less invasive than penetrating keratoplasty
  • No risk of rejection
  • Can be removed when penetrating keratoplasty is to be done

Complications include:

  • Insignificant peripheral opacities
  • Epithelial ingrowth
  • Neovascularization of the graft-recipient interface that may requires graft replacement
  • Recurrent erosions
  • Persistent epithelial defect
  • Graft melt