IN ADVANCED keratoconus or in keratoglobus, a tectonic lamellar graft is often required to build up the corneal thickness previous to a penetrating keratoplasty. In some instances, one may prefer to perform a lamellar graft in an eye with keratoconus as a definitive procedure. In these cases, there is a risk of perforation if one uses a dissector over the apex of the cone or in an area of thinning. The technique of Enrique Malbran, MD,1 takes advantage of the fact that, in keratoconus, there is already a partial separation of the corneal lamellae in the area of the cone; therefore, once the dissection has been started, the corneal lamellae can be pulled off the eye very easily without risk of rupturing.
A 10 or 11 mm trephine is required. The plunger is removed from the trephine whose edges are lightly stained with 1% methylene blue. A superficial
Polack FM. Lamellar KeratoplastyMalbran's "Peeling Off" Technique. Arch Ophthalmol. 1971;86(3):293-295. doi:10.1001/archopht.1971.01000010295010