A new surgical technique for deep stromal, anterior lamellar keratoplasty

Aims-To describe a new surgical technique for deep stromal anterior lamella r keratoplasty. Methods-In eye bank eyes and sighted human eyes, aqueous was exchanged by a ir, to visualise the posterior corneal surface-that is, the "air to endothe lium" interface. Through a 5.0 mm scleral incision, a deep stromal pocket w as created across the cornea, using the air to endothelium interface as a r eference plane for dissection depth. The pocket was filled with viscoelasti c, and an anterior corneal lamella was excised. A full thickness donor butt on was sutured into the recipient bed after stripping its Descemet's membra ne. Results-In 25 consecutive human eye bank eyes, a 12% microperforation rate was found. Corneal dissection depth averaged 95.4% (SD 2.7%). Six patient e yes had uneventful surgeries; in a seventh eye, perforation of the lamellar bed occurred. All transplants cleared. Central pachymetry ranged from 0.62 to 0.73 mm. Conclusion-With this technique a deep stromal anterior lamellar keratoplast y can be performed with the donor to recipient interface just anterior to t he posterior corneal surface. The technique has the advantage that the diss ection can be completed in the event of inadvertent microperforation, or th at the procedure can be aborted to perform a planned penetrating keratoplas ty.