A simple surgical technique for splitting a single donor cornea for performing deep anterior lamellar keratoplasty and Descemet membrane endothelial keratoplasty without using a microkeratome

Purpose: To describe a simple manual surgical technique for splitting a single-donor eye for performing both deep anterior lamellar keratoplasty ( DALK) and Descemet membrane endothelial keratoplasty (DMEK) without using a microkeratome. Methods: Twenty-three eyes with anterior stromal pathology and 23 eyes with irreversible endothelial dysfunction were evaluated for keratoplasty at a tertiary eye care referral center. Twenty-three healthy donor corneas were split into two parts. The Descemet's membrane was stripped and used for DMEK. The stripped stroma was used for DALK. Best-corrected visual acuity (BCVA) of both DALK and DMEK, endothelial cell density, and endothelial cell loss in DMEK were noted at 1-year follow-up, along with any intraoperative or postoperative complications and failures. Results: In the DALK group, mean BCVA improved from 1.264 +/- 0.25 log Mar preoperatively to 0.355 +/- 0.27 log Mar at 12 months follow-up. There were no complications and failures. In the DMEK group, mean BCVA improved from 1.537 +/- 0.61 log Mar preoperatively to 0.592 +/- 0.67 log Mar and the mean donor ECD was 3071.66 (range, 2783-3487) cells/mm(2) preoperatively, which was reduced to 1989.33 (range, 1546-2543) cells/mm(2) at 12 months follow-up indicating a mean endothelial cell loss of 35%. The failure rate was 21.7%. Conclusion: This study demonstrates that with a single donor corneal tissue, both DALK and DMEK can be performed successfully without any complications. Our technique will help corneal surgeons in all developing countries to cost effectively perform more lamellar surgeries and help in reducing the magnitude of corneal blindness without the need for expensive microkeratomes.