Deep lamellar keratoplasty - Surgical techniques for anterior lamellar keratoplasty with and without baring of Descemet's membrane

Purpose. To review current techniques used in deep anterior lamellar keratoplasty (LKP), and to describe a novel approach that facilitates baring of Descemet's membrane (maximum depth anterior lamellar keratoplasty). Methods. A highly selective review of the literature is presented, with descriptions of different techniques in the light of the authors' personal experience over 3 decades. A novel method for baring Descemet's membrane is detailed. It involves air injection in such a way that a large bubble is created between stroma and Descemet's membrane. Visual results of this operation in patients with keratoconus are reviewed. Results. Visual results 6 months after maximum depth anterior LKP in 181 eyes with keratoconus are comparable with those resulting from penetrating keratoplasty: 89% achieved a best spectacle-corrected Visual acuity of 20/40 or better, and 10% achieved 20/20 or better. Intraoperative perforation occurred in 9% of cases. Conclusions. Maximum depth anterior LKP has some important advantages when compared with other types of anterior lamellar keratoplasty or penetrating keratoplasty. but it remains a challenging procedure, A new technique considerably facilitates this operation and reduces intraoperative complications.