Deep lamellar keratoplasty: surgical techniques for anterior lamellar keratoplasty with and without baring of Descemet's membrane

Cornea. 2002 May;21(4):374-83. doi: 10.1097/00003226-200205000-00009.


Purpose: To review current techniques used in deep anterior lamellar keratoplasty (LKP), and to describe a novel approach that facilitates baring of Descemet's membrane (maximum depth anterior lamellar keratoplasty).

Methods: A highly selective review of the literature is presented, with descriptions of different techniques in the light of the authors' personal experience over 3 decades. A novel method for baring Descemet's membrane is detailed. It involves air injection in such a way that a large bubble is created between stroma and Descemet's membrane. Visual results of this operation in patients with keratoconus are reviewed.

Results: Visual results 6 months after maximum depth anterior LKP in 181 eyes with keratoconus are comparable with those resulting from penetrating keratoplasty: 89% achieved a best spectacle-corrected visual acuity of 20/40 or better, and 10% achieved 20/20 or better. Intraoperative perforation occurred in 9% of cases.

Conclusions: Maximum depth anterior LKP has some important advantages when compared with other types of anterior lamellar keratoplasty or penetrating keratoplasty, but it remains a challenging procedure. A new technique considerably facilitates this operation and reduces intraoperative complications.

MeSH terms

  • Air
  • Corneal Diseases / surgery*
  • Corneal Transplantation / methods*
  • Descemet Membrane / surgery*
  • Humans
  • Injections
  • Suture Techniques
  • Visual Acuity