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Chapter-09 Planned Near-Descemet's Dissection in Deep Lamellar Keratoplasty, Using Air and Fluid

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

Author
1. Teichmann Klaus D
2. Anwar Mohammed
ISBN
9788180616051
DOI
10.5005/jp/books/10883_9
Edition
1/e
Publishing Year
2006
Pages
9
Author Affiliations
1. King Khaled Eye Specialist Hospital in Riyadh, Kingdom of Saudi Arabia, Member of International Intraocular Implant Club (IIIC), King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
2. El Magrabi Specialist Hospital, Jeddah, Kingdom of Saudi Arabia
Chapter keywords

Abstract

Modern techniques of deep lamellar keratoplasty (LKP) have produced visual results like penetrating keratoplasty (PKP). Exposure of Descemet’s membrane in the recipient eye provides a shiny and optically smooth surface. Moving to the donor cornea, the Descemet’s membrane can then be peeled off the posterior aspect of the donor button, generating another mostly uniform and rather smooth surface. When this donor stromal disc is sutured into the recipient corneal bed over the exposed host Descemet’s membrane, the stroma-to-Descemet’s interface is comparable to the natural pre-Descemet’s plane. Since a stroma-to-stroma interface is absent, visual results resembling those of PKP are achieved. Near-Descemet’s dissection can be performed safely and reliably. It is ideal in situations not suitable for the big bubble procedure, or where the surgeon has been unable, despite repeated attempts, to achieve a big-bubble. Although initially the stromal dissection is somewhat tedious and time consuming, with experience it can usually be performed in 10 to 20 minutes. The thin layer of residual stroma does not seem to cause any significant interface problems and visual rehabilitation is usually good. Visual results are, however, better when Descemet’s membrane could be successfully exposed over the entire central cornea.

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