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A Modified Deep Anterior Lamellar Keratoplasty Using Intacs Dissectors

Purpose: To describe a new technique for deep anterior lamellar keratoplasty in the human eye. Methods: We obtained globes from the San Diego Eye Bank and performed central and peripheral pachymetry measurements at the 8-mm optical zone. We made a radial incision at the edge of the optical zone at 90% depth of central corneal thickness. We enlarged the incision and started lamellar dissection. The curved tunnel was created using dissecting instruments (Addition Technology, Des Plaines, IL), used in Intacs channels. With a sweeping motion, we connected these channels. An 8-mm Barron Radial Vacuum Trephine (Baron Precision Instruments, LLC, Grand Blanc, MI) was placed over the optical zone until the 90% depth of thickness was reached. The cap tissue was detached and viscoelastic was used to separate Descemet membrane and stromal tissue. We photographed the surface for analysis. Results: This technique was easy to perform with little remaining posterior stromal tissue. Residual tissue could easily be dissected, and the vacuum trephine could easily reach the same depth of the pocket. The outer edge of the bed had a clean sharp edge. The stromal bed surface and the inner corneal cap were smooth. Conclusions: We conclude that this modified technique is easy to perform and results in a more regular stromal surface. This technique may reduce the need for penetrating keratoplasty.