Mechanical Microkeratomes

  • Elena AlbéEmail author
  • Massimo Busin


During the last decade several techniques of lamellar keratoplasty (LK) have been developed with the purpose of retaining the advantages of penetrating keratoplasty (PK) while avoiding the removal of healthy portions of the cornea, thus selectively replacing the dysfunctional parts, limiting the rate of rejection, and increasing long-term graft stability. This chapter will review the different instruments and techniques to prepare donor tissue for endothelial keratoplasty (EK) and deep anterior lamellar keratoplasty (DALK). Descemet’s stripping automated endothelial keratoplasty (DSAEK) foresees the transplantation of a donor graft consisting of endothelium, Descemet’s membrane, and a variable amount of posterior stroma in case of eyes with decompensated endothelium. In order to optimize visual rehabilitation, the present trend is toward minimizing the amount of stroma transplanted, and this can be done with both single- and double-cut procedures. DALK has been gaining popularity as the optimal approach for treating non-endothelial disorders affecting Bowman’s layer and stroma. Hand dissection of the stroma is technically difficult, and the quality of the surfaces obtained is rarely compatible with optimal vision, while pneumatic dissection technique as the “big bubble” is difficult to learn and can be complicated by micro-macro perforations making a conversion to PK necessary. As an alternative, microkeratome-assisted LK has the advantage of being a standardized, technically easy procedure, yielding extremely smooth dissected surfaces, therefore compatible with 20/20 vision.


Microkeratome Artificial anterior chamber Descemet’s stripping automated endothelial keratoplasty Deep anterior lamellar keratoplasty Microkeratome-assisted lamellar keratoplasty 


  1. 1.
    Ward DE, Nesburn AB. An artificial anterior chamber. Am J Ophthalmol. 1976;82:796–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Wong DW, Chan WK, Tan DT. Harvesting a lamellar graft from a corneoscleral button: a new technique. Am J Ophthalmol. 1997;123:688–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Barraquer JI. The history and evolution of keratomileusis. Int Ophthalmol Clin. 1996;36(4):1–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Krumeich JH. Indications, techniques, and complications of myopic keratomileusis. Int Ophthalmol Clin. 1983;23(3):75–92.CrossRefPubMedGoogle Scholar
  5. 5.
    Krumeich JH, Swinger CA. Nonfreeze epikeratophakia for the correction of myopia. Am J Ophthalmol. 1987;103(3, Pt II):397–403.CrossRefPubMedGoogle Scholar
  6. 6.
    Slade SG, Updegraff SA. Advances in lamellar refractive surgery. Int Ophthalmol Clin. 1994;34(4):147–62.CrossRefPubMedGoogle Scholar
  7. 7.
    Pallikaris IG, Papatzanaki ME, Stathi EZ, Frenschock O, Georgiadis A. Laser in situ keratomileusis. Lasers Surg Med. 1990;10(5):463–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Jin GJ, Lyle WA. Initial results of automated lamellar keratoplasty for correction of myopia: one year follow-up. J Cataract Refract Surg. 1996;22(1):31–43.CrossRefPubMedGoogle Scholar
  9. 9.
    Schultze RL. Microkeratome update. Int Ophthalmol Clin. 2002;42(4):55–65.CrossRefPubMedGoogle Scholar
  10. 10.
    Lee JK, Nkyekyer EW, Chuck RS. Microkeratome complications. Curr Opin Ophthalmol. 2009;20(4):260–3.CrossRefPubMedGoogle Scholar
  11. 11.
    Jacobs JM, Taravella MJ. Incidence of intraoperative flap complications in laser in situ keratomileusis. J Cataract Refract Surg. 2002;28:23–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Nakano K, Nakano E, Oliveira M, et al. Intraoperative microkeratome complications in 47,094 laser in situ keratomileusis surgeries. J Refract Surg. 2004;20:S723–6.PubMedGoogle Scholar
  13. 13.
    Carrillo C, Chayet AS, Dougherty PJ, et al. Incidence of complications during flap creation in LASIK using the NIDEK MK-2000 microkeratome in 26,600 cases. J Refract Surg. 2005;21:S655–7.PubMedGoogle Scholar
  14. 14.
    Yau CW, Cheng HC. Microkeratome blades and corneal flap thickness in LASIK. Ophthalmic Surg Lasers Imaging. 2008;39:471–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Alio JL, Penero DP. Very high-frequency digital ultrasound measurement of the LASIK flap thickness profile using the intralase femtosecond laser and M2 and carriazo-pendular microkeratomes. J Refract Surg. 2008;24:12–23.PubMedGoogle Scholar
  16. 16.
    Khachikian SS, Morason RT, Belin MW, et al. Thin head and single use microkeratomes reduce epithelial defects during LASIK. J Refract Surg. 2006;22:482–5.PubMedGoogle Scholar
  17. 17.
    Randleman JB, Lynn MJ, Banning CS, et al. Risk factors for epithelial defect formation during laser in situ keratomileusis. J Cataract Refract Surg. 2007;33:1738–43.CrossRefPubMedGoogle Scholar
  18. 18.
    Chen YT, Tseng SH, Ma MC, et al. Corneal epithelial damage during LASIK: a review of 1873 eyes. J Refract Surg. 2007;23:916–23.PubMedGoogle Scholar
  19. 19.
    Albelda-Valles JC, Martin-Reyes C, Ramos F, et al. Effect of preoperative keratometric power on intraoperative complications in LASIK in 34,099 eyes. J Refract Surg. 2007;23:592–7.PubMedGoogle Scholar
  20. 20.
    Busin M, Patel AK, Scorcia V, et al. Microkeratome-assisted preparation of ultrathin grafts for descemet stripping automated endothelial keratoplasty. Invest Ophthalmol Vis Sci. 2012;53:521–4.CrossRefPubMedGoogle Scholar
  21. 21.
    Busin M, Madi S, Santorum P, et al. Ultrathin descemet’s stripping automated endothelial keratoplasty with the microkeratome double-pass technique: two-year outcomes. Ophthalmology. 2013;120(6):1186–94.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of OphthalmologyIstituto Clinico HumnaitasRozzanoItaly
  2. 2.Department of OphthalmologyVilla Igea HospitalForlìItaly

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