REVIEW  MODERN TECHNIQUES OF LAMELLAR KERATOPLASTY 

Minerva Oftalmologica 2018 December;60(4):196-206

DOI: 10.23736/S0026-4903.18.01817-2

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Large (9 mm) deep anterior lamellar keratoplasty with clearance of a 6-mm optical zone

Pia LEON ^{1, 2} ✉, Saverio LUCCARELLI ^{2, 3}, Massimo BUSIN ^{2, 4}

¹ SS. Giovanni e Paolo Hospital, Venice, Italy; ² Villa Igea Private Hospitals, Forlì, Forlì-Cesena, Italy; ³ University Eye Clinic, San Giuseppe Hospital, Milan, Italy; ⁴ Department of Morphology, Surgery and Experimental Surgery, University of Eye Clinic, University of Ferrara, Ferrara, Italy

Newer variants of deep anterior lamellar keratoplasty (DALK) technique have emerged in the last decade, targeted to replace diseased corneal stroma with health endothelium selectively. Recent improvements in surgical instruments and the introduction of new imaging systems, have resulted in the standardization of DALK as an acceptable alternative to conventional PK. In this article, a deep trephination within 150 μm from the endothelial surface allows pneumatic dissection to be performed successfully in a very high percentage of cases even by surgeons with minimal experience of keratoplasty surgery. Moreover, the air injection from a cannula advanced minimally from the base of a deep trephination eliminates the need for subjective judgment of the depth reached during cannula advancement to the center of the cornea. Results concerning visual acuity, refractive outcomes, and graft survival rate are analyzed and reported.

KEY WORDS: Corneal transplantation - Surgical procedures, operative - Cornea