Air pumping technique simplifies DALK, increases rate of big bubble creation

Lamellar keratoplasty encompasses both anterior lamellar keratoplasty and posterior lamellar keratoplasty. This form of transplantation technique is called selective corneal transplantation, in which only the diseased portions of the cornea are removed and replaced with similar layers of healthy donor corneal tissue, thus retaining the healthy regions of the recipient cornea.There are several benefits of selective corneal transplantation, the most important being the negation of endothelial corneal graft rejection. Figure 1 shows the John-Malbran lamellar keratoplasty classification that was introduced in 2006; it is based on the amount of recipient cornea that is removed and replaced, and it includes superficial anterior lamellar keratoplasty, mid anterior lamellar keratoplasty, deep anterior lamellar keratoplasty and total anterior lamellar keratoplasty. In performing anterior lamellar keratoplasty, the surgeon needs to be familiar with more than one technique so that he is able to change technique as needed during surgery to complete cases that may be more complex and challenging.