Securing the Anterior Chamber in Penetrating Keratoplasty

Abstract

Conventional penetrating keratoplasty (PK) is an open-sky procedure, carrying a worrisome risk of expulsive suprachoroidal hemorrhage and vitreous prolapse in high-risk cases. The authors propose an innovative surgical technique that secures the intraoperative anterior chamber and should reduce the risk of vitreous complications. In the new stabilized procedure, a deep anterior corneal lamella is excised. A small puncture is made in each quadrant along the groove of the stromal bed, and the anterior chamber is maintained by viscoelastic injection. The viscoelastic-coated graft is sutured near the 4 puncture sites. After sequential cutting of the stromal bed and suturing of the graft, the residual stromal bed is excised and drawn out before the last suture is placed. Fifteen PK patients have undergone this procedure without complications. Satisfactory vision recovery was achieved in all 15 of the stabilized PK eyes, and the mean postoperative endothelial cell loss was comparable to studies performed for open PK. The authors believe that the reduced risks and limited endothelial cell loss verify the significance and practicability of the stabilized PK. This innovative new technique adds security for keratoplasty candidates who are at high risk for vitreous prolapse or suprachoroidal hemorrhage.