A surgical technique for posterior lamellar keratoplasty

Cornea. 1998 Nov;17(6):618-26. doi: 10.1097/00003226-199811000-00010.


Purpose: To design a surgical technique for transplantation of posterior corneal tissue, while leaving the recipient anterior cornea intact.

Methods: In human cadaver eyes, and in a cat and monkey model, recipient eyes had an 8.0-mm limbal incision made with a diamond blade set to 50% of central pachymetry. A stromal pocket was created across the cornea, and a 6.0-mm diameter posterior lamellar disc was excised. A donor posterior disc was implanted into the recipient opening, and the limbal incision was sutured. The procedure was evaluated with keratometry, biomicroscopy, endothelial (supra)vital staining, and light microscopy.

Results: In human cadaver eyes, post-operative astigmatism averaged 1.2 D (SD, +/- 0.6 D). Posterior transplants showed an intact endothelial cell layer with 1.0% (SD, +/- 1.2%) of cell death. In the animals, six (75%) eyes had clear transplants 2 weeks after surgery; one of these eyes later developed an allograft rejection. Two (25%) eyes showed corneal decompensation, because of inverted implantation of the donor disc. Microscopy showed minimal scarring at the donor-to-host interface and a normal wound-healing response at the posterior stromal wound edges.

Conclusion: In experimental models, posterior lamellar keratoplasty can be performed through a limbal incision and a mid-stromal pocket. The procedure may be a potential alternative in the surgical management of corneal endothelial disorders.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Astigmatism / etiology
  • Astigmatism / pathology
  • Cadaver
  • Cats
  • Cornea / cytology
  • Cornea / surgery*
  • Corneal Transplantation / adverse effects
  • Corneal Transplantation / methods*
  • Feasibility Studies
  • Follow-Up Studies
  • Graft Rejection / etiology
  • Graft Rejection / pathology
  • Haplorhini
  • Humans
  • Postoperative Complications / etiology
  • Postoperative Complications / pathology
  • Tissue Donors
  • Wound Healing