Intralamellar Dissection Techniques in Lamellar Keratoplasty

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Abstract
To evaluate and compare the efficacy of the four adjunctive agents to facilitate recipient bed intralamellar dissection in cases of lamellar keratoplasty. Forty eyes with partial-thickness corneal opacities were recruited for this prospective, randomized clinical trial. The cases were divided into four groups per the intralamellar injection (i.e., air [group I], 2% hydroxypropyl methylcellulose [HPMC] [group II], balanced saline solution [BSS] [group III], and no adjunct [group IV] used to facilitate recipient intralamellar dissection). The intraoperative parameters evaluated were initial preparation time, dissection time, and total time. At each follow-up, visual acuity, refractive status, keratometry, and endothelial cell counts were also analyzed. Initial preparation time, dissection time, and total time were significantly decreased with the use of an adjunct (p < 0.05) and were found to be least with the use of BSS. No difference in these time frames was noted between group I and group II. Corneal haze and incomplete air insufflation were seen in group I, and difficulty in injection of 2% HPMC and its incomplete spread were noted in group II. The mean spherical equivalent, astigmatism, endothelial cell counts, and visual acuity did not show any significant difference between any group. Hydrodelamination with BSS is easy to perform and should be undertaken routinely to facilitate recipient intralamellar dissection.

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