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Chapter-10 Viscoelastic Dissection in Deep Lamellar Anterior Keratoplasty

BOOK TITLE: Surgical Techniques in Anterior and Posterior Lamellar Corneal Surgery

Author
1. Haw Weldon W
2. Manche Edward E
ISBN
9788180616051
DOI
10.5005/jp/books/10883_10
Edition
1/e
Publishing Year
2006
Pages
6
Author Affiliations
1. UCSD School of Medicine, 9415 Campus Point Drive, La Jollam, CA 92093-0946, USA, UCSD School of Medicine, and Shiley Eye Center, Chief of Ophthalmology, San Diego VA Health Services, San Diego, CA, USA, San Diego, CA, USA, Corneal, Cataract and Refractive Surgery, UCSD School of Medicine, 9415 Campus Point Drive, La Jollam, CA 92093-0946, USA, 300 Pasteur Drive, Stanford, USA
2. Stanford University School of Medicine, 900 Blake Wilbur Drive, W 3002, Stanford, CA 94304, USA, Stanford University School of Medicine, Stanford, CA, USA, 300 Pasteur Drive, Stanford, USA
Chapter keywords

Abstract

In the past few years, new lamellar keratoplasty (LKP) techniques have become available for the management of various anterior corneal disorders. Although patients with superficial corneal disorders may benefit from phototherapeutic keratectomy and automated LKP, disorders of the deeper cornea stroma may require more refined, complex, and surgically demanding techniques. The success of the technically demanding technique of deep LKP revolves around appropriate dissection of the posterior cornea stroma completely from Descemet’s membrane without entering the anterior chamber. Since the cornea stroma is comprised of lamellae with several “artificial layers,” this can be achieved using techniques other than sharp dissection. One promising technique that has gained some interest in recent years involves deep anterior LKP using dissection of the corneal stroma from Descemet’s membrane using a viscoelastic. Deep LKP using viscoelastic dissection is a promising technique that has broadened the array of therapeutic options available for corneal disorders and provided a viable alternative to PKP. This method may offer several distinct advantages over sharp dissection methods of deep LKP methods including smaller perforation rates and less interface opacification. As compared to PKP, deep LKP procedures reduce the risk of devastating postoperative infections (i.e. endophthalmitis) and endothelial rejection, and results in less wound healing issues. With the improvements in modern lamellar surgical techniques, the re-emergence of deep anterior LKP is expected to result in continued improved outcomes in corneal lamellar surgery.

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