title: A new surgical technique for deep stromal, anterior lamellar keratoplasty.
abstract: OBJECTIVE
  To describe a new surgical technique for deep stromal anterior lamellar keratoplasty.
  
  
  METHODS
  In eye bank eyes and sighted human eyes, aqueous was exchanged by air, to visualise the posterior corneal surface--that is, the "air to endothelium" interface. Through a 5.0 mm scleral incision, a deep stromal pocket was created across the cornea, using the air to endothelium interface as a reference plane for dissection depth. The pocket was filled with viscoelastic, and an anterior corneal lamella was excised. A full thickness donor button was sutured into the recipient bed after stripping its Descemet's membrane.
  
  
  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 eyes 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.
  
  
  CONCLUSIONS
  With this technique a deep stromal anterior lamellar keratoplasty can be performed with the donor to recipient interface just anterior to the posterior corneal surface. The technique has the advantage that the dissection can be completed in the event of inadvertent microperforation, or that the procedure can be aborted to perform a planned penetrating keratoplasty.
authors.affiliation: Rotterdam Eye Hospital, Netherlands.
authors.forename: G R
authors.initials: GR
authors.lastname: Melles
authors.forename: F
authors.initials: F
authors.lastname: Lander
authors.forename: F J
authors.initials: FJ
authors.lastname: Rietveld
authors.forename: L
authors.initials: L
authors.lastname: Remeijer
authors.forename: W H
authors.initials: WH
authors.lastname: Beekhuis
authors.forename: P S
authors.initials: PS
authors.lastname: Binder
mesh_terms: D000328:Adult; D003316:Corneal Diseases / Q000601:surgery*; D003319:Corneal Stroma / Q000293:injuries / Q000601:surgery*; D016039:Corneal Transplantation / Q000009:adverse effects / Q000379:methods*; D005125:Eye Banks; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged