Case Report: PDF OnlyManual DALK in Keratoconus An Ex Vivo Light and Transmission Electron Microscopy Analysis 2 Years After SurgeryFavuzza, Eleonora PhD*; Mencucci, Rita MD*; Rosa, Irene PhD†; Cennamo, Michela MD*; Manetti, Mirko PhD†; Marini, Mirca PhD†Author Information *Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), Eye Clinic, University of Florence, Largo Brambilla, Florence, Italy; and †Department of Experimental and Clinical Medicine, Section of Anatomy and Histology, University of Florence, Largo Brambilla, Florence, Italy. Correspondence: Rita Mencucci, MD, Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), Eye Clinic, University of Florence, Largo Brambilla 3, 50134 Florence, Italy (e-mail: [email protected]). The authors have no funding or conicts of interest to disclose. E. Favuzza and R. Mencucci contributed equally to this work. Received January 14, 2021 Received in revised form February 25, 2021 Accepted March 13, 2021 Cornea: April 28, 2021 - Volume - Issue - doi: 10.1097/ICO.0000000000002752 Buy PAP Metrics Abstract Purpose: The aim of this study was to evaluate the microscopic structure of a human cornea 2 years after manual deep anterior lamellar keratoplasty (DALK) for keratoconus with a recipient residual stromal bed thickness of 100 μm, using light and transmission electron microscopy. Methods: A human cornea treated with manual DALK for keratoconus 2 years before was removed during penetrating keratoplasty because of stromal opacity of unknown origin, involving about half of the sample. The transparent half of the specimen was processed for light and transmission electron microscopy. Results: Light microscopy examination performed with different staining techniques (hematoxylin and eosin, Picrosirius red, and Masson trichrome) revealed a homogeneous stroma. No interface was detected. Electron microscopy confirmed these findings. Conclusions: This study confirmed the available clinical and confocal studies that show progressive stromal remodeling after manual DALK. Two years after surgery, no posterior stromal interface was detected. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.