ALK Disaster

The 4 images below are of the same eye that underwent a procedure known as “Automated Lamellar Keratoplasty” or simply “ALK”. To the best of my knowledge, ALK is not done any longer due to the many complications associated with it. This procedure used a microkeratome (a small slicing machine) to alter the shape of the cornea. This eye was very farsighted (hyperopia) before undergoing ALK. In an effort to eliminate the hyperopia, a condition known as corneal ectasia corneal ectasia was created. What resulted was a very steep distorted dry cornea that left this patient with 20/400 vision in this eye which could not be corrected with eyeglasses or contact lenses. In the first photo look carefully at the pupil around 4:00. Note the corneal haze. This is a result of this surgery. The 2nd photo shows a more magnified view of the corneal haze. The third photo was taken through a biomicroscope using a special dye and filter to highlight the area of the cornea that was surgically altered. Note the round outlined shape in the center of the photo. This area of the cornea is 6 mm in diameter and is extremely distorted and steep. The dark areas in the center are areas of the cornea devoid of moisture. The last image was taken with a technology known as “optical coherence tomography” or simply “OCT”. In this image the thick curved grey structure is the cornea. The 2 lines above the cornea represent the front and back surfaces of a scleral lens. The curved pointed outline in the center of the cornea is where the cornea was surgically altered. There is no surgical procedure that will undo the damage done to this eye by this surgery. The only technology that will allow an eye like this to function visually again is a well designed and fit scleral lens. This patient now has 20/20 undistorted vision with this eye with the scleral lens.