Posterior corneal disorders for which a penetrating keratoplasty is commonly performed, include aphakic and pseudophakic bullous keratopathy, and Fuchs endothelial dystrophy. Although up to 60-90% graft clarity five years postoperative has been reported for these disorders, penetrating keratoplasty is often complicated by high and/or irregular astigmatism, insufficient wound healing, or suture-related problems.

Fewer complications may be expected when only the diseased, posterior corneal layers would be replaced by donor tissue. In the 1980s, Barraquer clinically performed transplantation of posterior corneal tissue underneath an anterior flap. Recently, Culbertson et al. and Busin et al. described a similar technique for transplanting a 6.5 mm posterior corneal button, using a microkeratome to create a 9.5 mm anterior corneal flap. In a series of seven eyes, the postoperative astigmatism was less than 4 diopters in all eyes.

The purpose of this on-line course is to describe the our technique for posterior lamellar keratoplasty through a 9.0 mm corneo-scleral pocket incision, or a 5.0 mm scleral tunnel incision.