Outcomes of Air Injection Within 2 mm Inside a Deep Trephination for Deep Anterior Lamellar Keratoplasty in Eyes With Keratoconus




We would like to congratulate Busin and associates for their attempt at standardizing deep anterior lamellar keratoplasty in their work titled “Outcomes of Air Injection Within 2 mm Inside a Deep Trephination for Deep Anterior Lamellar Keratoplasty in Eyes With Keratoconus.” The manuscript highlights the importance of performing pneumodissection in the deep stroma, which had already been elegantly described by the same group in a previous paper using intraoperative anterior segment optical coherence tomography. The same concepts have been applied in 2 similar techniques used by Ghanem and associates and our group, in which a diamond blade incision set at a specified depth is used as a guide for reaching a deep stromal plane during pneumodissection, which is performed after advancing the air injection cannula toward the central cornea. These techniques rely on the assumption that as the cannula advances, the cannula remains in the deep cornea. In a section of the manuscript, the authors imply that in the techniques described by Ghanem and associates and Knutsson and associates, the pachymetric measurements for the precalibrated diamond knife incision are performed using the “use of central or paracentral pachymetric values.” In our opinion, this phrase is imprecise, as the pachymetric measurements are indeed paracentral (located approximately 1 mm inside the trephination groove) but are localized in the precise area in which the precalibrated incision will be made. The main novelty of the approach described by Busin and associates is the concept of performing pneumodissection with a slight advancement of the cannula (only 2 mm) starting from a deep pachymetry-guided peripheral trephination. It would be interesting to compare the 2 different approaches in a prospective study involving only inexperienced surgeons in both a laboratory and clinical setting in order to establish which techniques can yield higher success rates of bubble formation.

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Jan 5, 2017 | Posted by in OPHTHALMOLOGY | Comments Off on Outcomes of Air Injection Within 2 mm Inside a Deep Trephination for Deep Anterior Lamellar Keratoplasty in Eyes With Keratoconus
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