Air lamellar keratoplasty.

Lamellar keratoplasties often result in decreased postoperative visual acuity from irregularities and opacities in the interface, sometimes have difficulty in matching the thickness of the resected recipient bed and the donor tissue, and may develop vascularization of the host-donor interface. I describe my experience with a new technique of injecting air into the corneal stroma to form a plane of dissection for deep lamellar keratectomy just anterior to Descemet's membrane. A full thickness donor button with the endothelium removed was used. Results are reported on ten eyes of ten patients. Follow-up ranged from 6 to 15 months (mean, 11 months). Three cases were converted to penetrating keratoplasty at the time of surgery and one five months after surgery. Of the remaining six, only one had a dissection completely to Descemet's membrane. All six recovered spectacle-corrected visual acuity of 20/40 or better. The technical limitations of this procedure are described.