A new lamellar wound configuration for penetrating keratoplasty surgery.

A modified penetrating keratoplasty procedure with a new lamellar configuration of the surgical wound was performed on 8 eyes with endothelial decompensation. This technique allows complete suture removal by 3 months postoperatively, substantially shortening the time necessary for visual rehabilitation. Refractive astigmatism before and after suture removal was minimized to 4 diopters or less in all of the eyes in our preliminary series. Because the anterior surface of the donor button is smaller than the posterior one (diameter, 7.0 mm and 9.0 mm, respectively), more endothelial cells can be transplanted while maintaining the anterior graft surface at a safe distance from the corneoscleral limbus. Finally, no expensive instrumentation is required for this procedure except for an artificial anterior chamber if whole globes are not available. The surgical technique and clinical results are presented in this article.