In experimental models, posterior lamellar keratoplasty can be performed through a limbal incision and a mid-stromal pocket. The procedure may be a potential alternative in the surgical management of corneal endothelial disorders.

Aims-To describe a new surgical technique for deep stromal anterior lamellar keratoplasty. Methods-In eye bank eyes and sighted human eyes, aqueous was exchanged by air, to visualise the posterior corneal surface−that is, the "air to endothelium" interface. 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 viscoelastic, and an anterior corneal lamella was excised. A full thickness donor button was sutured into the recipient bed after stripping its Descemet's membrane. Results-In 25 consecutive human eye bank eyes, a 12% microperforation rate was found. Corneal dissection depth averaged 95.4% (SD 2.7%). Six patient eyes had uneventful surgeries; in a seventh eye, perforation of the lamellar bed occurred. All transplants cleared. Central pachymetry ranged from 0.62 to 0.73 mm. Conclusion-With this technique a deep stromal anterior lamellar keratoplasty can be performed with the donor to recipient interface just anterior to the posterior corneal surface. The technique has the advantage that the dissection can be completed in the event of inadvertent microperforation, or that the procedure can be aborted to perform a planned penetrating keratoplasty. (Br J Ophthalmol 1999;83:327-333)

DM can be transplanted in vitro with acceptable damage to the donor endothelium and with little induced astigmatism.

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Sutureless, posterior lamellar keratoplasty may be an effective new surgical approach for managing corneal endothelial disorders.

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