To the Editor:
Water-impermeable transparent membranes of polypropylene or polymethyl methacrylate have been placed intralamellarly in patients having bullous keratopathy.1-4 This procedure is of little help because, although the stroma in front of the membrane dehydrates and the epithelial edema disappears, the posterior stroma becomes even more edematous and eventually scars.3 Ideally, in corneal edema the fluid barrier should be placed as far posteriorly as possible. Filling most of the anterior chamber with silicone oil is effective against edema and is nonirritating, but its side effects make it impractical for clinical application.5More promising is the addition of a cylindrical posterior extension to the intralamellar membrane, thus bypassing the edematous and opaque posterior stroma. The simultaneous introduction of nontoxic transparent silicone rubber as implant material resulted in a mushroom-like silicone implant, which can be buried under a full-thickness graft or in the patient's own cornea. We have
Dohlman CH, Brown SI, Martola E. ARTIFICIAL CORNEAL ENDOTHELIUM. Arch Ophthalmol. 1966;75(3):453–454. doi:10.1001/archopht.1966.00970050455031
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