A quick surgical technique for deep, anterior lamellar keratoplasty using visco-dissection.
OBJECTIVE
To describe a new surgical technique for deep, anterior lamellar keratoplasty using a viscoelastic for dissection of Descemet's membrane (DM) from the posterior stroma.


METHODS
Through a paracentesis, aqueous was exchanged 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 was injected to separate DM from the posterior stroma, and a recipient, anterior lamella was excised. A full-thickness donor button was sutured into the 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 visco-dissection. With light microscopy, dissection depth was located at the level 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 converted into a penetrating keratoplasty.


CONCLUSIONS
Using visco-dissection, a lamellar keratoplasty can be performed quickly, with the donor-to-recipient interface just above the recipient DM, i.e., with a nearly perfect anatomical replacement of all corneal stroma. There is substantial risk of rupture or microperforation of DM during surgery.
Cornea Service, Rotterdam Eye Hospital, The Netherlands. melles@oogziekenhuis.nl
G R
GR
Melles
L
L
Remeijer
A J
AJ
Geerards
W H
WH
Beekhuis
D000328:Adult; D003317:Corneal Dystrophies, Hereditary / Q000473:pathology / Q000601:surgery*; D003319:Corneal Stroma / Q000637:transplantation*; D016039:Corneal Transplantation / Q000379:methods*; D003886:Descemet Membrane / Q000293:injuries / Q000601:surgery; D005125:Eye Banks; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D007640:Keratoconus / Q000473:pathology / Q000601:surgery*; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D012421:Rupture / Q000517:prevention & control; D014019:Tissue Donors; D014792:Visual Acuity