Air-guided manual deep lamellar keratoplasty.

PURPOSE. To evaluate the efficacy of a new modified technique of deep lamellar keratoplasty (DLK). METHODS. Nine eyes of eight patients with keratoconus of moderate degree were included. All patients underwent DLK with manual dissection from a limbal side port after an air bubble injection in the anterior chamber. The patients underwent a complete ophthalmologic examination 6 months after the suture removal, evaluating best-corrected visual acuity, corneal thickness, endothelial cell count, and topographic astigmatism. RESULTS. One case (11.1%) was converted to penetrating keratoplasty because of microperforation. In the eight successful cases, 7 eyes (77.8%) achieved 20/30 or better visual acuity 6 months after suture removal. Mean postoperative pachymetry was 604.76 μm (SD 46.76). Specular microscopy 6 months after suture removal revealed average endothelial cell count of 2273/mm 2 (SD 229). CONCLUSIONS. This modified DLK technique is a safe and effective procedure and could facilitate, after a short learning curve, this kind of surgery with a low risk of conversion to penetrating keratoplasty.