Intralamellar dissection techniques in lamellar keratoplasty

Area of Science:

• Ophthalmology
• Surgical Techniques
• Corneal Surgery

Background:

• Lamellar keratoplasty requires precise dissection of the recipient corneal bed.
• Adjunctive agents can potentially facilitate this intralamellar dissection process.
• Optimizing surgical time and technique is crucial for patient outcomes.

Purpose of the Study:

• To compare the efficacy of four agents (air, 2% hydroxypropyl methylcellulose [HPMC], balanced saline solution [BSS], and no adjunct) in facilitating recipient bed intralamellar dissection during lamellar keratoplasty.
• To evaluate the impact of these agents on intraoperative parameters and postoperative outcomes.

Main Methods:

• A prospective, randomized clinical trial involving 40 eyes with partial-thickness corneal opacities.
• Patients were divided into four groups receiving different intralamellar injections: air, 2% HPMC, BSS, or no adjunct.
• Intraoperative parameters (preparation, dissection, total time) and postoperative outcomes (visual acuity, refractive status, keratometry, endothelial cell count) were assessed.

Main Results:

• Adjunctive agents significantly decreased initial preparation, dissection, and total surgical times (p < 0.05).
• Balanced saline solution (BSS) demonstrated the shortest times compared to other agents.
• Air injection caused corneal haze and incomplete insufflation; 2% HPMC presented injection and spread difficulties. No significant differences in visual acuity or endothelial cell counts were observed between groups.

Conclusions:

• Hydrodelamination using BSS is an effective and easily performed method to facilitate recipient intralamellar dissection in lamellar keratoplasty.
• Routine use of BSS for hydrodelamination is recommended to improve surgical efficiency.