A quick surgical technique for deep, anterior lamellar keratoplasty using visco-dissection

Purpose, To describe a new surgical technique for deep, anterior lamellar k eratoplasty using a viscoelastic for dissection of Descemet's membrane (DM) from the posterior stroma. Methods. Through a paracentesis, aqueous was ex changed by air to visualize the posterior corneal surface-i.e., the air-to- endothelium interface. Using the interface as a reference plane, a 30 gauge needle was inserted into the cornea to just anterior to DM. Viscoelastic w as injected to separate DM from the posterior stroma, and a recipient, ante rior lamella was excised. A full-thickness donor button was sutured into th e recipient bed, after stripping its DM. Results. In 25 eye bank eyes, the procedure could be completed in 20 eyes; in 5 eyes, DM ruptured during visc o-dissection. With light microscopy, dissection depth was located at the le vel of DM. In two patient eyes the procedure could be completed. In a third patient eye DM ruptured during visco-dissection, and the procedure was con verted into a penetrating keratoplasty. Conclusion. Using visco-dissection, a lamellar keratoplasty can be performed quickly, with the donor-to-recipi ent interface just above the recipient DM, i.e., with a nearly perfect anat omical replacement of all corneal stroma. There is substantial risk of rupt ure or microperforation of DM during surgery.