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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.

Clinical Sciences

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.

From the Cornea Service, Rotterdam Eye Hospital, Rotterdam, The Netherlands.

Submitted September 1, 1999.

Revision received November 11, 1999.

Accepted November 23, 1999.

Supported by the Technology Foundation STW, Applied Science Division of NWO, and The Technology Program of the Ministry of Economic Affairs.

Address correspondence and reprint requests to Dr. Gerrit R.J. Melles, the Rotterdam Eye Hospital, Schiedamse Vest 180, P.O. Box 70030, 3000 LM Rotterdam, The Netherlands. E-mail:

© 2000 Lippincott Williams & Wilkins, Inc.