Deep lamellar keratoplasty: surgical techniques for anterior lamellar keratoplasty with and without baring of Descemet's membrane.
OBJECTIVE
To review current techniques used in deep anterior lamellar keratoplasty (LKP), and to describe a novel approach that facilitates baring of Descemet's membrane (maximum depth anterior lamellar keratoplasty).


METHODS
A highly selective review of the literature is presented, with descriptions of different techniques in the light of the authors' personal experience over 3 decades. A novel method for baring Descemet's membrane is detailed. It involves air injection in such a way that a large bubble is created between stroma and Descemet's membrane. Visual results of this operation in patients with keratoconus are reviewed.


RESULTS
Visual results 6 months after maximum depth anterior LKP in 181 eyes with keratoconus are comparable with those resulting from penetrating keratoplasty: 89% achieved a best spectacle-corrected visual acuity of 20/40 or better, and 10% achieved 20/20 or better. Intraoperative perforation occurred in 9% of cases.


CONCLUSIONS
Maximum depth anterior LKP has some important advantages when compared with other types of anterior lamellar keratoplasty or penetrating keratoplasty, but it remains a challenging procedure. A new technique considerably facilitates this operation and reduces intraoperative complications.
Anwar
Mohammed
M
Department of Ophthalmology, Magrabi Eye & Ear Hospital, Jeddah, Saudi Arabia. med_dir@magrabi.com.sa
Teichmann
Klaus D
KD
D000388:Air; D003316:Corneal Diseases / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D003886:Descemet Membrane / Q000601:surgery*; D006801:Humans; D007267:Injections; D013536:Suture Techniques; D014792:Visual Acuity