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Logo of brjopthalBritish Journal of OphthalmologyVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Br J Ophthalmol. 1999 March; 83(3): 327–333.
PMCID: PMC1722959

A new surgical technique for deep stromal, anterior lamellar keratoplasty


AIMS—To describe a new surgical technique for deep stromal anterior lamellar keratoplasty.
METHODS—In eye bank eyes and sighted human eyes, aqueous was exchanged by air, to visualise the posterior corneal surface−that is, the "air to endothelium" interface. Through a 5.0 mm scleral incision, a deep stromal pocket was created across the cornea, using the air to endothelium interface as a reference plane for dissection depth. The pocket was filled with viscoelastic, and an anterior corneal lamella was excised. A full thickness donor button was sutured into the recipient bed after stripping its Descemet's membrane.
RESULTS—In 25 consecutive human eye bank eyes, a 12% microperforation rate was found. Corneal dissection depth averaged 95.4% (SD 2.7%). Six patient eyes had uneventful surgeries; in a seventh eye, perforation of the lamellar bed occurred. All transplants cleared. Central pachymetry ranged from 0.62 to 0.73 mm.
CONCLUSION—With this technique a deep stromal anterior lamellar keratoplasty can be performed with the donor to recipient interface just anterior to the posterior corneal surface. The technique has the advantage that the dissection can be completed in the event of inadvertent microperforation, or that the procedure can be aborted to perform a planned penetrating keratoplasty.

Keywords: corneal surgery; lamellar keratoplasty; air; optical interface

Figure 1
Diagrammatic representation of the deep, anterior lamellar keratoplasty technique. (A) After dissection of a deep stromal pocket through a scleral incision. (B and C) Viscoelastic is injected into the pocket, and an anterior corneal lamella is trephinated ...
Figure 2
Demonstration of the surgical technique in a human eye bank eye. (A) The anterior chamber has been filled with air. In between the blade tip and the air to endothelial interface light reflex, a dark band (arrowheads) is visible. (B) Because the dark ...
Figure 3
Demonstration of the surgical technique in a human eye bank eye. (A) The pocket is dissected first across the vertical meridian, and then extended sideways up to the limbus over 360°, with the same spatula. Note that the anterior chamber is completely ...
Figure 4
Light microscopy of a deep lamellar dissection through a scleral incision in a human eye bank eye. (A) A deep stromal dissection level (arrowheads) is seen (98% corneal depth). (B) Few stromal lamellae (arrows) are visible between the stromal dissection ...
Figure 5
Slit lamp photograph 6 months (patient eye 1) after deep, anterior lamellar keratoplasty. A clear lamellar corneal transplant is visible, with a deep stromal, donor to recipient interface (arrow).

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