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Updated: Apr 18, 2026
Corneal Donor Tissue Preparation for Endothelial Keratoplasty
Published on: June 12, 2012
Surgical technique for graft exchange after big-bubble deep anterior lamellar keratoplasty
Vincenzo Scorcia1, Jacqueline Beltz, Andrea Lucisano
1*Department of Ophthalmology, University of "Magna Graecia," Catanzaro, Italy; †Centre For Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia; ‡Department of Ophthalmology, Ospedale Privato "Villa Igea," Forlì, Italy; and §Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IiRFO), Forlì, Italy.
Purpose:
The aim of this study was to describe a surgical technique for repeat deep anterior lamellar keratoplasty (DALK) by baring Descemet membrane again in eyes affected by stromal opacity of the donor lamella.
Methods:
Repeat DALK was performed in 5 eyes of 5 patients affected by central stromal opacity not involving the endothelium; indications for repeat surgery were postbacterial or postherpetic corneal scars (n = 3), postphotorefractive keratectomy haze (n = 1), and recurrence of granular dystrophy (n = 1). The surgical procedure consisted of the following: (1) superficial trephination, 250 μm in depth, on the original peripheral scar; (2) blunt detachment of the donor graft completed by means of corneal forceps; (3) apposition of the new lamella. Best spectacle-corrected visual acuity, topographic astigmatism, and endothelial cell density were evaluated preoperatively, as well as 3, 6, 9, 12, and 18 months after surgery.
Results:
At the latest follow-up examination, with all sutures removed from all eyes, the best spectacle-corrected visual acuity was 20/30 or better in all cases with 3 eyes achieving 20/20. Postoperative refractive astigmatism averaged 3.0 ± 1.2 diopters (mean ± SD); endothelial cell density was not significantly affected by surgery.
Conclusions:
Repeat DALK is effective in removing diseased corneal stroma while keeping the recipient endothelium unaffected; the procedure is simple and does not require pneumatic dissection, thus eliminating the most challenging surgical step; postoperative visual recovery does not differ from that experienced after primary DALK.
