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Research and development of ophthalmic surgical techniques |
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tel +31 (0)10 485 4882, fax +31 (0)10 485 2419 |
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Research and development of ophthalmic surgical techniques |
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tel +31 (0)10 485 4882, fax +31 (0)10 485 2419 |
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On-line instruction course:
A surgical technique for deep, anterior lamellar keratoplasty (DALK) 
A technique is described for deep, anterior lamellar keratoplasty (DALK) using manual dissection through a scleral tunnel incision, or visco-dissection of Descemets membrane. The key to performing the procedure succesfully is to master a few surgical tricks, to get the feel of the instruments, and to carefully select your patients. The essential micro-surgical manouvres are not easily explained and/or shown in articles or at scientific meetings. An on-line instruction course may better meet these purposes, as one of the most convenient types of media currently available for displaying text and photographs. The content of this on-line course is also available on a Cd-rom + live-surgery video. In addition, hands-on-skill surgical training courses are organized at some of the international ophthalmology meetings, and at the NIIOC/DORC in Rotterdam/Zuidland, The Netherlands. I hope you will enjoy this on-line course. If I can be of further assistance, please contact me at melles@niioc.nl. Gerrit R.J. Melles, M.D., Ph.D.
Abstract
Aims/background. To describe a new surgical technique for deep stromal, anterior lamellar keratoplasty.
Methods. Through a paracentesis aqueous was exchanged by air, to visualize the air-to-endothelium interface, i.e. the posterior corneal surface. Through a 5.0 mm scleral incision, a deep stromal pocket was created across the cornea, using the air-to-endothelium interface as a reference plane for dissection depth. The pocket was filled with visco-elastic, and an anterior corneal lamella was excised. Alternatively, a visco-elastic was injected just anterior to Descemets membrane, to separate Descemets membrane from the posterior stroma, and to displace Descemets membrane toward the iris.
After trephination of a 7.5 to 9.0 mm recipient anterior lamellar button, the recipient stromal bed was thoroughly irrigated. After stripping its Descemets membrane, a full-thickness donor button was sutured into the recipient bed. Patients were examined before surgery, and 6, 12 and 24 months after surgery.
Results.
A micro-perforation occurred in seven of the 68 (10%) eyes in which manual dissection with a spatula was performed, and in 4 (50%) eyes in which visco-dissection was performed. In these cases the procedure was converted into a penetrating keratoplasty. In one eye, the interface was later irrigated to remove residual visco elastic.
Conclusions. DALK by manual dissection through a scleral tunnel incision has a low perforation rate, and a good visual outcome with low postoperative astigmatism at six months and one year after surgery. The technique has the advantage that the dissection can be completed in the event of inadvertent micro-perforation, or that the procedure can be aborted to later perform a planned penetrating keratoplasty. Although a smooth recipient stromal bed may be obtained much faster using visco-dissection, it is more often complicated by perforation, i.e. a rupture of Descemets membrane.
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