1. Fragmentary-circular keratoplasty (FCK) is a surgical technique to correct high myopia involving implantation of circular corneal transplant fragments. 2. The technique involves splitting a donor cornea into layers and making parallel sections to create 4 implant fragments which are inserted into a circular tunnel in the recipient cornea to form a closed interlamellar ring. 3. Initial clinical results on 11 eyes of 8 patients found the technique provided stable correction of 9-13 diopters of myopia with good vision outcomes in most cases and no major complications.

1. Fragmentary-circular
keratoplasty for correction of
high myopia.
Gonchar P., Dushin N., Belyaev
V., Kravchinina V., Barashkov V.,
Frolov M.(Moscow)

2. ZIL Hospital
Russian People’s Friendship
University

3. Surgical correction of high
degree myopia.
Radial keratotomy.
LASIC, PRK.
Implantation of negative
precristaline lens.
Extraction of a clear lens.
Keratoplasty with a «ring».

4. Refractive interlamellar
keratoplasty.
First operations-
V.S. Belyaev
(1964)

5. Circular keratoplasty.
(interstromal ring)
1.Optic zone.
2.Incision in
paracentral corneal
zone.
3.Circular tunnel.
4.Alloimplantat.

6. Advantages
High refractive effect
8.0-15.0 diopters.
No deep incision of
the cornea.
Big intact optic zone.
Stable refractive
effect.

7. Disadvantages
Requires long
transplantat.
Complicated and
traumatic technique
of implantation.

8. Fragmentary-Circular
keratoplasty
(FCK)
2.Contact of implants
in tunnel.

9. Purpose of the work:
Simplify the technique of
transplantat implantation.
Optimize the parameters of
transplantats.
Clinical tests and analysis of
FCK.

10. Technique of FCK
involves:
1.Preparation of implants.
2.Procedure of operation.

11. Preparation of implants.
From cadaveric cornea.
Cornea is splited of
into 2 layers.
In the upper layer
Parallel sections are
made using double
edged knife.
The size of implants
depends upon the
degree of myopia to
be corrected.

12. Procedure
of the operation.
Optic zone of 5-6mm is
determined.
2 incisions are made at
6 &12 o,clock position&
a circular tunnel is
created.
4 fragments of the
circular transplant are
inserted into the tunnel
to form closed
interlamellar ring.

13. Visual & Refractial changers
(2 years after FCK)
-10.5 D.
8/200
-0.75 D.
20/20

14. 11 eyes - 8 patients
The myopia(stable) ranged from 9,0
-13,0 diopters. Age 21-36 years.
The size of fragments was
determined by keeping in view the
type & severity of clinical refraction:
The diameter of optic zone varied
from 4.5-6.0mm.
Postoperative follow up period was
RPFU from 6 months to 3 years.

15. VISUAL ACUITY WITHOUT
CORRECTION.
FOR 7(63.6%) cases
FOR 4(36.4%) cases
10/20
& more
6/20 &
more

16. DISCUSSION
We consider that complications
can be of technical nature only.In
our case no intraoperative
complication was found.
In one case irregular
postoperative astigmatism was
observed which was later
overcome by replacement of one
ring fragment.

17. Comments of the patients:
80% were fully satisfied
with the positive results .
Stable effect.
Night vision remained
uneffected.
Watering from eyes in early
postoperative period was a
single compliant in a few
cases.

18. Conclusions:
The clinical tests prove the efficiency of the FCK
for correction of high degree myopia.
FCK gives good vision & the effect is stable.
The technique is very simple.
Further clinical researches for indications &
contrindications of the offered method is
necessary.
Removal/replacement of 1 or more ring fragments
makes the technique a reversible one.