title: Deep anterior lamellar keratoplasty with a manual spatula: anatomical and functional results.
abstract: OBJECTIVE
  Evaluate the anatomical, refractive, and functional results of an innovative technique of deep anterior lamellar keratoplasty with a manual spatula.
  
  
  METHODS
  We evaluated the results and examinations of 16 eyes from 14 patients who underwent deep anterior lamellar keratoplasty using the technique described by Ferrara. Residual bed thickness after keratoplasty was evaluated postoperatively using Visante. The measurement was performed using a technique similar to that used to measure flap thickness after laser in situ keratomileusis refractive surgery. The measurements were performed at the center of the cornea in an area comprising the central 3-mm in the 45° and 135° meridians.
  
  
  RESULTS
  Best-corrected visual acuity was 0.34 ± 0.18 LogMar (0.09 to 0.60 LogMar), the spherical equivalent was -4.31 ± 3.38 D (+0.25 to -9.50 diopters), and keratometry was 45.75 ± 2.77 D (41.11 to 52.48 diopters) postoperatively. Corneal astigmatism was 3.19 ± 2.78 D (0.18 to 11.81 diopters). Residual stromal bed thickness measured by optical coherence tomography showed values of 67.1 ± 24.3 μm (30 to 109 μm). The statistical correlation by Spearman's test between the best-corrected visual acuity and the residual stromal bed thickness was 0.11 (P = 0.67).
  
  
  CONCLUSIONS
  Deep anterior lamellar keratoplasty, in which manual dissection was performed using an instrument similar to that used to implant corneal rings, provided good visual and anatomical results.
authors.affiliation: Division of Cornea and External Disease, Clinics Hospital, University of São Paulo, HCFMUSP-SP, Division of Refractive Surgery of UNICO SP, Brazil.
authors.forename: Mário Henrique Camargos
authors.initials: MH
authors.lastname: de Lima
authors.forename: Alex Roque
authors.initials: AR
authors.lastname: Rizzi
authors.forename: Rosangela Aparecida
authors.initials: RA
authors.lastname: Simoceli
authors.forename: Fernando Betty
authors.initials: FB
authors.lastname: Cresta
authors.forename: Milton Ruiz
authors.initials: MR
authors.lastname: Alves
mesh_terms: D000328:Adult; D003315:Cornea / Q000033:anatomy & histology* / Q000601:surgery*; D016039:Corneal Transplantation / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D012029:Refraction, Ocular; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D055815:Young Adult