title: Deep anterior lamellar keratoplasty using an original manual technique.
abstract: OBJECTIVE
  To evaluate the clinical findings and visual outcomes of deep anterior lamellar keratoplasty (DALK) using an original manual dissection technique.
  
  
  METHODS
  288 eyes (268 patients) with corneal pathologies without endothelial involvement were treated by DALK using an original manual dissection technique guided by a calibrated knife incision based on ultrasonic pachimetry values. Clinical records were examined retrospectively at 2 months, 6 months, 1 year and 2 years. The following outcomes were measured: visual acuity, topographic parameters, endothelial cell density and recipient stromal residue thickness.
  
  
  RESULTS
  At the 2-year postoperative follow-up, the mean logarithm of the minimum angle of resolution best spectacle corrected visual acuity (BSCVA) was 0.131±0.087 and topographic astigmatism was 2.87±1.57 diopters. In 12 cases (4.2%) a perforation of Descemet's membrane required conversion of the procedure to penetrating keratoplasty. Mean optical coherence tomography (OCT) residue thickness (measured in 82 eyes with OCT Visante) was 31.63±24.57 μm; lower values of recipient residue thickness were significantly associated with higher BSCVA (Spearman coefficient 0.635, p< 0.001).
  
  
  CONCLUSIONS
  DALK using a dry manual dissection technique provides visual, refractive and clinical results comparable to other deep lamellar techniques. Eyes with lower values of recipient residue thickness are associated with better visual acuity.
authors.affiliation: Ospedale San Raffaele, Unità Cornea e Superficie Oculare, Via Olgettina 60, Milano 20132, Italy. rama.paolo@hsr.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Rama
authors.forename: Karl Anders
authors.initials: KA
authors.lastname: Knutsson
authors.forename: Giulia
authors.initials: G
authors.lastname: Razzoli
authors.forename: Stanislav
authors.initials: S
authors.lastname: Matuska
authors.forename: Maurizia
authors.initials: M
authors.lastname: Viganò
authors.forename: Giorgio
authors.initials: G
authors.lastname: Paganoni
mesh_terms: D000293:Adolescent; D000328:Adult; D001251:Astigmatism / Q000503:physiopathology; D002452:Cell Count; D003316:Corneal Diseases / Q000601:surgery*; D063171:Corneal Pachymetry; D019781:Corneal Topography; D016039:Corneal Transplantation / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012029:Refraction, Ocular / Q000502:physiology*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*; D055815:Young Adult