title: A surgical technique for posterior lamellar keratoplasty.
abstract: OBJECTIVE
  To design a surgical technique for transplantation of posterior corneal tissue, while leaving the recipient anterior cornea intact.
  
  
  METHODS
  In human cadaver eyes, and in a cat and monkey model, recipient eyes had an 8.0-mm limbal incision made with a diamond blade set to 50% of central pachymetry. A stromal pocket was created across the cornea, and a 6.0-mm diameter posterior lamellar disc was excised. A donor posterior disc was implanted into the recipient opening, and the limbal incision was sutured. The procedure was evaluated with keratometry, biomicroscopy, endothelial (supra)vital staining, and light microscopy.
  
  
  RESULTS
  In human cadaver eyes, post-operative astigmatism averaged 1.2 D (SD, +/- 0.6 D). Posterior transplants showed an intact endothelial cell layer with 1.0% (SD, +/- 1.2%) of cell death. In the animals, six (75%) eyes had clear transplants 2 weeks after surgery; one of these eyes later developed an allograft rejection. Two (25%) eyes showed corneal decompensation, because of inverted implantation of the donor disc. Microscopy showed minimal scarring at the donor-to-host interface and a normal wound-healing response at the posterior stromal wound edges.
  
  
  CONCLUSIONS
  In experimental models, posterior lamellar keratoplasty can be performed through a limbal incision and a mid-stromal pocket. The procedure may be a potential alternative in the surgical management of corneal endothelial disorders.
authors.affiliation: Rotterdam Eye Hospital, Rotterdam, The Netherlands. melles@oogziekenhuis.nl
authors.forename: G R
authors.initials: GR
authors.lastname: Melles
authors.forename: F A
authors.initials: FA
authors.lastname: Eggink
authors.forename: F
authors.initials: F
authors.lastname: Lander
authors.forename: E
authors.initials: E
authors.lastname: Pels
authors.forename: F J
authors.initials: FJ
authors.lastname: Rietveld
authors.forename: W H
authors.initials: WH
authors.lastname: Beekhuis
authors.forename: P S
authors.initials: PS
authors.lastname: Binder
mesh_terms: D000818:Animals; D001251:Astigmatism / Q000209:etiology / Q000473:pathology; D002102:Cadaver; D002415:Cats; D003315:Cornea / Q000166:cytology / Q000601:surgery*; D016039:Corneal Transplantation / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000473:pathology; D000882:Haplorhini; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology; D014019:Tissue Donors; D014945:Wound Healing