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Vito Romano, Adrian Tey, Natalie Hill, Jern Chen, Claire Britten, Sajjad Ahmad, Mark Batterbury, Colin E Willoughby, Stephen Kaye; Preparation of large grafts for Endothelial Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2700.
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© ARVO (1962-2015); The Authors (2016-present)
To describe a technique to achieve a large thin posterior lamellar graft for endothelial keratoplasty in order to increase the amount of peripheral endothelium that is transplanted
After thinning of the donor cornea, the anterior 350um of corneal stroma was removed with a microkeratome. A manual lamellar dissection was then performed to remove the remaining anterior peripheral circumferential margin of donor tissue. A 9.5mm graft was then trephined from the endothelial surface, inserted into the anterior chamber and tamponaded against the recipient's bared posterior cornea with air. Cord lengths and sag heights of the transplanted tissue were measured using anterior segment OCT.
Twenty-four patients underwent this modified technique. All patients had well-attached endothelial grafts with the graft edge achieving good clearance from the peripheral iris and anterior chamber angles. Cord lengths of the graft inside the eye were reduced due to the increased radius of curvature of the posterior corneal surface. Central and peripheral graft thickness were 100-150um and 180-200um, respectively.
The modified technique reduces the thickness of the peripheral cornea outside of the region removed by the automated trephine enabling larger trephine sizes to be used. A larger graft is expected to provide approximately 10-20% more transplanted endothelial cells.
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