Objective: To evaluate the effect of the deep lamellar keratoplasty technique in preserving Descemet's membrane and the patient's endothelial cells, using corneoscleral donor button. Methods: 14 lamellar keratoplasties were performed with viscodissection of the receptor's Descemet's membrane using 4% chondroitin sulphate and 3% sodium hyaluronate. Ten (10) patients presented advanced keratoconus, 3 had herpes simplex leucoma and 1 had corneal irregularity due to a previous radial keratotomy. Postoperative follow-up varied from 12 to 48 months (average 24 ± 10.5 months). Results: After all sutures had been removed, the spherical equivalent on the last ophthalmic examination was -2.0 ± 3.6 diopters (D) (-10,3 D to +4,74 D). Final astigmatism varied from -6,0 CD to -0,75 CD with an average of -3,3 ± 1,9 CD. Twelve of 14 patients presented a best spectacle corrected visual acuity of 20/40 or better on the last examination. All patients gained Snellen lines. Postoperatively there was no corneal edema, endothelial decompensation, rejection, interface opacity nor deposits. Two patients developed Descemet's folds accounting for low visual acuity. Conclusion: In spite of technical difficulties related to lamellar keratoplasty and viscodissection of Descemet's membrane, we believe that this is a procedure of choice in patients whose endothelial cells population is preserved. This technique results in better final visual acuity when compared to the traditional lamellar transplant, and less immunologic reaction when compared to penetrating keratoplasty. Because the receptor's endothelium was preserved, surgeries resulted in transparent corneas, regardless of the donor's tissue quality.
Corneal transplantation; Descemet's membrane
