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Surgical Technique
November 1999

Deep Lamellar Keratoplasty Using Viscoelastic Dissection

Author Affiliations

From the Department of Ophthalmology, Stanford University School of Medicine, Stanford, Calif (Dr Manche); Department of Ophthalmology, Jules Stein Eye Institute, University of California at Los Angeles (Dr Holland); and the Maloney Vision Institute, Los Angeles (Dr Maloney).

Arch Ophthalmol. 1999;117(11):1561-1565. doi:10.1001/archopht.117.11.1561

We describe a technique for performing deep lamellar keratoplasty using viscoelastic dissection. Deep lamellar dissections of the cornea using viscoelastic substances (sodium hyaluronate) were performed on 4 eyes of 4 patients. One patient with keratoconus and another with corneal scarring underwent lamellar keratoplasty using the technique as the sole procedure for visual rehabilitation. Two patients (2 eyes) with opaque corneas underwent deep lamellar dissection with removal of stromal tissue to allow visualization of the anterior segment structures prior to penetrating keratoplasty, thereby facilitating separation of iridocorneal adhesions as the Descemet membrane was incised. Deep lamellar dissection was performed without complications related to the procedure in all 4 eyes. The 2 lamellar grafts cleared completely, and both eyes achieved excellent visual acuity with spectacle correction. In the other 2 eyes, deep lamellar dissection provided clear visualization of anterior segment structures during incision of the Descemet membrane. Deep lamellar dissection using viscoelastic substances is a useful technique during lamellar keratoplasty.