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Blunt scissors stromal dissection technique for deep anterior lamellar keratoplasty

Authors Anwar D, Kruger M, Mootha V

Received 1 March 2014

Accepted for publication 11 May 2014

Published 15 September 2014 Volume 2014:8 Pages 1849—1854

DOI https://doi.org/10.2147/OPTH.S63300

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2


This video shows the technique of using blunt scissors dissection to bare Descemet’s membrane.

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Didar S Anwar, Matthew M Kruger, V Vinod Mootha

Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA


Objective: We describe a modified technique for performing lamellar dissection in deep anterior lamellar keratoplasty after failure to achieve a “big bubble” detachment of Descemet’s membrane (DM) with deep intrastromal pneumatic injection.
Methods: The technique utilizes blunt lamellar dissection with blunt-tipped corneal mini scissors as an alternative to a crescent blade, which can be difficult for surgeons to master and is associated with a high risk of perforation.
Results: Other techniques of blunt dissection, such as the Melles technique, cannot be utilized after failure to achieve a big bubble, as emphysema in the stroma prevents visualization of the spatula. In contrast, our blunt scissors lamellar dissection technique takes advantage of the emphysema and microdetachments of DM created by the pneumatic injection.
Conclusion: This technique provides deep anterior lamellar keratoplasty surgeons with a simple, alternative method of baring DM or achieving a pre-DM plane with minimal residual stroma, after failure to achieve a big bubble.

Keywords: scissors, blunt, dissection, big bubble, DALK


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