Fig. 5

DALK Melles Technique. First, the anterior chamber is filled with air and a partial trephination of 70 % of the corneal stroma is performed (a). Then, using a series of curved spatulas through a scleral pocket, the stroma is carefully dissected away from the underlying DM (b). The difference in refractive index between air and corneal tissue creates a reflex of the surgical spatulas, and the distance between the instrument and reflex is used to judge the amount of remaining underlying tissue (B, arrows). Viscoelastic is injected through the scleral incision into the stromal pocket and the dissection can be completed through the trephination edge (c). Once completed, the superficial stroma is removed (d), the DM exposed e, and the donor cornea sutured (f)