Intralamellar dissection techniques in lamellar keratoplasty

Purpose. To evaluate and compare the efficacy of the four adjunctive agents to facilitate recipient bed intralamellar dissection in cases of lamellar keratoplasty. Methods, Forty eyes with partial-thickness corneal opacities were recruited for this prospective, randomized clinical trial. The cases w ere divided into four groups per the intralamellar injection (i.e., air [gr oup I], 2% hydroxypropyl methylcellulose [HPMC] [group II], balanced saline solution [BSS] [group III], and no adjunct [group IV] used to facilitate r ecipient intralamellar dissection). The intraoperative parameters evaluated were initial preparation time, dissection time, and total time. Ar each fo llow-up, visual acuity, refractive status, keratometry, and endothelial cel l counts were also analyzed. Results, Initial preparation time, dissection time, and total time were significantly decreased with the use of an adjunc t (p < 0.05) and were found to be least with the use of BSS. No difference in these time frames was noted between group I and group II. Corneal haze a nd incomplete air insufflation were seen in group I, and difficulty in inje ction of 2% HPMC and its incomplete spread were noted in group II. The mean spherical equivalent, astigmatism, endothelial cell counts, and visual acu ity did not show any significant difference between any group. Conclusion. Hydrodelamination with BSS is easy to perform and should be undertaken rout inely to facilitate recipient intralamellar dissection.