Rectangular Autogenous Lamellar Keratoplasty.

MANY of the stationary corneal opacities causing diminution of vision are central, avascular, and superficial, and are surrounded by clear cornea or have a neighbouring peripheral clear corneal area of 4 x 4-5 mm. Donor homogenous corneal grafts are not always available, but a rectangular lamellar autogenous corneal. graft can be dissected and turned 1800 so that the clear lamellae are brought in front of the pupil and the opaque lamellae lie peripherally. Morax (1913) utilized a hand trephine with which two equal circles were marked out in the same cornea, one in the leucoma opposite the pupil and the other in a transparent peripheral area. The leucomatous lamellae were cut as deeply as necessary but the transplant zone was entered only slightly and this disc was applied on the area of the removed leucoma. The opaque disc might or might not be applied. No sutures were placed, the transplant adhering well with only bandaging and rest. In case of central leucoma, Gradle (1921) trephined an area 6 mm. in diameter, half embracing the leucoma and half a transplant collateral area. After lamellar dissection of the corneal disc, it was rotated 180° so that the transparent area occupied the pupillary field.