An improved method for lamellar keratoplasty

Lamellar keratoplasty seldom provides visual results comparable to those possible from penetrating keratoplasty. Although lamellar keratoplasty is most useful in treating disorders of the anterior corneal stroma, postoperative visual acuity is often compromised because of scarring at the graft-host interface, residual opacities of the recipient tissue, or distortion of the corneal surface. This paper describes a technique for lamellar keratoplasty in which the stromal surface of the donor cornea is prepared preoperatively on a cryolathe. The donor tissue produced has a smooth stromal surface and accurately determined thickness, and can be stored frozen until surgery. In a series of 63 lamellar keratoplasties, 56 were performed using cryolathed donor tissue. Eighteen of these were attempted for optical purposes, and all but one obtained visual acuity within one Snellen line of the patient's maximum potential. Eleven of the 18 achieved 20/40 or better acuity, and five realized 20/20 or better. With the application of cryolathed donor corneas, lamellar keratoplasties can produce excellent optical results without the risks inherent in penetrating keratoplasty.