The Double-Deck Viscoelastic Technique: a Novel Surgical Technique to Protect the Corneal Endothelium in Penetrating Keratoplasty of Aphakic Silicone Oil-Dependent Eyes after Severe Ocular Injury

Introduction The purpose of this study is to summarize the benefits of the double-deck viscoelastic technique (DDVT), a novel and cost-effective surgical technique that creates a barrier to hinder silicone oil (SO) from connecting and damaging the corneal endothelium in aphakic and SO-dependent eyes. Methods Five SO-dependent and aphakic eyes underwent double-deck viscoelastic embedment and penetrating keratoplasty (PKP) in this retrospective case series. At 1, 6, 12, 18, and 24 months after surgery, clinical outcomes including best corrected visual acuity (BCVA), intraocular pressure (IOP), corneal endothelial cell density (ECD), and double-deck viscoelastic layer imaging were evaluated. A Heidelberg Retina Tomograph confocal microscope was used to measure ECD. Ultrasound biomicroscopy (UBM) was used to image the double-deck viscoelastic layer. Results Postoperatively, the BCVA of the patients ranged from hand motion detection to 20/200, and their IOP was between 7 and 10 mmHg. The two-deck viscoelastic layer remained mostly static. Patients showed varying degrees of ECD reduction, with ECD loss rates in the first 6 months ranging from 6.7 to 75.8 cells/mm 2 /month and then declining to 2.2–14.3 cells/mm 2 /month. Conclusion In SO-dependent aphakic eyes, double-deck viscoelastic embedment could effectively inhibit SO-corneal endothelium interaction. This technique could lower the pace of ECD loss and lengthen the time of corneal transparency, giving aphakic and silicone oil-dependent patients the opportunity to accept PKP surgery and get better vision quality.