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“Tuck In” Lamellar Keratoplasty (TILK) for corneal ectasias involving corneal periphery


Aims: Evaluation of a new surgical technique for the management of corneal ectasia with peripheral corneal involvement.

Methods: Twelve eyes of 12 patients with corneal ectasias and peripheral corneal thinning requiring surgical intervention, including eight patients with combined keratoconus and PMD and four patients of keratoglobus, were enrolled for the study in a tertiary care hospital. All patients were contact lens intolerant and had a best corrected visual acuity (BCVA) ⩽20/120 with nine patients (75%) having BCVA ⩽20/200. “Tuck In” Lamellar Keratoplasty (TILK) that included a central lamellar keratoplasty with intrastromal tucking of the peripheral flange was performed in these patients. The main outcome measures analysed were uncorrected visual acuity (UCVA), BCVA, keratometry, refractive status and time for epithelial healing.

Results: At the last follow-up (mean: 1.7 years (range 13–48 months)), six patients (50.0%) had BCVA ⩾20/60, and all patients had BCVA ⩾20/80. The mean keratometry decreased from 57.54 (SD 6.89) D preoperatively to 46.36 (2.39) D (p = 0.003), and the mean spherical equivalent (SEQ) refractive error decreased from –7.8 (4.6) D preoperatively to 1.23 (1.88) D (p = 0.007). A significant decrease was also seen in mean refractive astigmatism which decreased from 5.93 (3.06) D preoperatively to 3.23 (1.14) D (p = 0.037).

Conclusion: Our technique of TILK is an effective surgical modality for the management of ectatic corneal dystrophies with peripheral corneal thinning.

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    Harminder S Dua Arun D Singh, Editors-in-Chief