Enhanced Surgical Safety through Protective Penetrating Keratoplasty: A Retrospective Analysis of 22 Cases

Figure 1

Photographs of the major steps in the protective penetrating keratoplasty procedure. (a) The cornea was marked with a 7.5-mm manual trephine, and the corneal epithelium was removed. (b) The donor cornea was trephinated from its endothelial face using an 8.0-mm Barron trephine on a Teflon block. (c) Nonpenetrating incisions in four quadrants and lamellar stromal dissection were performed. (d) Lamellar dissection was performed in up to 80% of the recipient’s stroma. (e) The donor corneal tissue was placed and secured to the recipient’s bed. (f) If necessary, synechiotomy was performed in the incised sector in patients with anterior chamber iris synechiae. (g) Continuous anterior chamber penetrating incisions (1/4 circumference each) were made. A suture was placed in the middle of each 1/4 to secure the donor cornea in the incised sector. (h) The remaining recipient corneal tissue was extracted from the unsutured quadrant. (i) Complete interrupted corneal suturing was performed.

(a)

(b)

(c)

(d)

(e)

(f)

(g)

(h)

(i)