[Corneal lamellar graft. Back to the future]

Transplantation of all of the corneal layers (penetrating keratoplasty) is the most common corneal grafting method, regardless of the indication. The surgical procedure is relatively simple but penetrating keratoplasty has several potential complications: --Unnecessary replacement of healthy recipient endothelium in diseases affecting only the anterior layers carries a risk of immune rejection. --Replacement of the anterior part of the cornea in diseases affecting only the posterior layers delays visual recovery Lamellar keratoplasty consists of replacing only the diseased corneal layers. Although it was the first procedure to be described, lamellar keratoplasty became less popular because it is technically difficult and often gives poor visual results due to imperfect lamellar dissection. Recent surgical advances have overcome these difficulties, and lamellar keratoplasty may well become the first-choice treatment for most stromal and endothelial diseases.