A surgical technique for posterior lamellar keratoplasty

G R Melles, F A Eggink, F Lander, E Pels, F J Rietveld, W H Beekhuis, P S Binder

    Research output: Contribution to journalArticleResearchpeer-review


    PURPOSE: To design a surgical technique for transplantation of posterior corneal tissue, while leaving the recipient anterior cornea intact.

    METHODS: In human cadaver eyes, and in a cat and monkey model, recipient eyes had an 8.0-mm limbal incision made with a diamond blade set to 50% of central pachymetry. A stromal pocket was created across the cornea, and a 6.0-mm diameter posterior lamellar disc was excised. A donor posterior disc was implanted into the recipient opening, and the limbal incision was sutured. The procedure was evaluated with keratometry, biomicroscopy, endothelial (supra)vital staining, and light microscopy.

    RESULTS: In human cadaver eyes, post-operative astigmatism averaged 1.2 D (SD, +/- 0.6 D). Posterior transplants showed an intact endothelial cell layer with 1.0% (SD, +/- 1.2%) of cell death. In the animals, six (75%) eyes had clear transplants 2 weeks after surgery; one of these eyes later developed an allograft rejection. Two (25%) eyes showed corneal decompensation, because of inverted implantation of the donor disc. Microscopy showed minimal scarring at the donor-to-host interface and a normal wound-healing response at the posterior stromal wound edges.

    CONCLUSION: 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.

    Original languageEnglish
    Pages (from-to)618-26
    Number of pages9
    Issue number6
    Publication statusPublished - Nov 1998


    • Animals
    • Astigmatism/etiology
    • Cadaver
    • Cats
    • Cornea/cytology
    • Corneal Transplantation/adverse effects
    • Feasibility Studies
    • Follow-Up Studies
    • Graft Rejection/etiology
    • Haplorhini
    • Humans
    • Postoperative Complications/etiology
    • Tissue Donors
    • Wound Healing


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