Grafting of the posterior cornea. Description of a new technique with 12-month clinical results.
OBJECTIVE
To describe the technique of grafting only the posterior cornea and to report 12-month clinical results.


METHODS
A two-layer technique with an anterior recipient flap created by a microkeratome and a posterior penetrating donor graft allows for a watertight wound closure and at the same time a peroperative correction of astigmatism. Four eyes (3 patients) were followed for 12 months.


RESULTS
The surgical technique could be completed in all cases without complications. The postoperative course was uneventful. The intrastromal absorbable sutures disappeared spontaneously and completely. Graft thickness showed the expected 6-month minimum while recipient flap thickness remained constant. After 1 year endothelial cell densities were 1200-2300 cells/mm2. Confocal microscopy showed activated keratocytes in the flap and quiescent keratocytes in the donor tissue by one year. The anterior chamber depth was normal in all cases. The optical quality of the cornea was studied by automatic keratometry and keratoscopy (TMS). The obtained optical properties were not optimal.


CONCLUSIONS
The developed novel technique gives a better wound closure and a complication free postoperative course. It may allow for better control of postoperative astigmatism. In order to disseminate the use of the technique, eyebanks should supply posterior corneas to the surgeon.
Ehlers
N
N
Department of Ophthalmology, Arhus University Hospital, Denmark. actaoph@post9.tele.dk
Ehlers
H
H
Hjortdal
J
J
Møller-Pedersen
T
T
D000368:Aged; D000867:Anterior Chamber / Q000033:anatomy & histology; D002452:Cell Count; D003315:Cornea / Q000166:cytology; D003316:Corneal Diseases / Q000601:surgery*; D019781:Corneal Topography; D016039:Corneal Transplantation / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005347:Fibroblasts / Q000166:cytology; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D013524:Surgical Flaps; D013536:Suture Techniques; D014019:Tissue Donors; D014792:Visual Acuity