Outcome of Deep Anterior Lamellar Keratoplasty Patients with Intraoperative Descemet's Membrane Perforation: A Retrospective Cross-sectional Study

Overview

Journal Indian J Ophthalmol

Specialty Ophthalmology

Date 2018 Oct 26

PMID 30355864

Citations 6

Authors

Shreesha Kumar Kodavoor

Bijita Deb

Dandapani Ramamurthy

Affiliations

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Abstract

Purpose: To evaluate functional and anatomical outcome in patients undergoing deep anterior lamellar keratoplasty (DALK) with intraoperative Descemet's membrane (DM) perforation (macro and micro).

Methods: A retrospective cross sectional study (January 2009 to December 2015) of sixteen eyes of sixteen patients which included nine patients of advanced keratoconus (KC), two patients with paracentral DM scarring post hydrops, KC with Bowman's membrane scarring, macular corneal dystrophy and one patient of advanced Pellucid Marginal Degeneration (PMD). All underwent DALK with intraoperative DM perforation. Big bubble technique was attempted in all except in the two patients with post hydrops DM scar. Preoperative and postoperative best corrected visual acuity (BCVA), astigmatism and endothelial count (EC) were compared.

Results: Postoperative BCVA and astigmatism were found to be better and statistically significant ('p value' 0.00 and 0.003 respectively). BCVA preoperative and postoperative was 1.07± 0.3 and 0.28 ± 0.09 in LogMAR respectively and astigmatism pre and postoperative 4.14 ± 1.5 D and 2.7 ± 0.97 D respectively. Percentage decrease in EC at sixth postoperative week was 7.48% and at sixth month and 1 year postoperative was 15.1%. Two patients developed postoperative double anterior chamber and two patients developed pupillary block glaucoma and all were successfully managed.

Conclusion: Not all patients of intraoperative DM perforation (including macro perforation) needs to be converted to penetrating keratoplasty. DALK can be successfully done if the perforation is identified early and managed adequately. This is the only known study which has shown a large series of successful DALK even with macro perforations.

Citing Articles

Complications in deep anterior lamellar keratoplasty - A retrospective cross sectional interventional analysis in a large series.

Kodavoor S, Rathi N, Dandapani R Oman J Ophthalmol. 2023; 16(1):23-29.

PMID: 37007267 PMC: 10062111. DOI: 10.4103/ojo.ojo_72_22.

Complications in deep anterior lamellar keratoplasty - A retrospective interventional analysis in a large series.

Kodavoor S, Rathi N, Dandapani R Indian J Ophthalmol. 2022; 70(10):3501-3507.

PMID: 36190035 PMC: 9789794. DOI: 10.4103/ijo.IJO_655_22.

Outcomes of deep anterior lamellar keratoplasty and penetrating keratoplasty in keratoconic eyes with and without previous hydrops.

Handel A, Luke J, Siebelmann S, Franklin J, Roters S, Matthaei M Graefes Arch Clin Exp Ophthalmol. 2022; 260(9):2913-2923.

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Deep Anterior Lamellar Keratoplasty with Large Descemet's Membrane Perforation: Should We Stop Conversion to Penetrating Keratoplasty?.

Goweida M, Mahmoud S, Sobhy M, Liu C J Curr Ophthalmol. 2021; 33(2):171-176.

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Preferred practice pattern and observed outcome of deep anterior lamellar keratoplasty - A survey of Indian corneal surgeons.

Fogla R, Sahay P, Sharma N Indian J Ophthalmol. 2021; 69(6):1553-1558.

PMID: 34011739 PMC: 8302320. DOI: 10.4103/ijo.IJO_3067_20.

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