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Clinical Sciences

A Quick Surgical Technique for Deep, Anterior Lamellar Keratoplasty Using Visco-dissection

Melles, Gerrit R.J. M.D., Ph.D.; Remeijer, Lies M.D.; Geerards, Annette J.M. M.D.; Beekhuis, W. Houdijn M.D.

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Purpose. 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.

Conclusion. 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.

© 2000 Lippincott Williams & Wilkins, Inc.


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