Abstract
Aims/Purpose: This case report aims to describe the posterior lamellar approach to manage stromal interface irregularity after deep anterior lamellar keratoplasty (DALK).Methods: A 42‐year‐old woman previously underwent DALK with visco‐bubble failed for keratoconus associated with intraoperative perforation. One year after surgery, she presented to our center with loss visual acuity. The recipient bed appeared wrinkled and opaque. The anterior optical surface was regular, with low and regular astigmatism. Endothelial cell density (ECD) could not be assessed. The planned surgical procedure consisted of a modified small diameter (7mm) DSAEK technique, in which only the small optic zone was replaced, resulting in a two‐piece mushroom graft configuration.Results: Corneal clarity was restored and complete attachment of the donor lamella was achieved. Postoperative best‐ corrected visual acuity (BCVA) reached 20/20. No intraoperative or postoperative complications were reported.Conclusions: To achieve the clearance of the recipient bed in eyes that have undergone manual DALK, the least invasive surgical strategy should be planned, preserving the healthy corneal tissue of the patient. Small diameter posterior lamellar keratoplasty has a lower incidence of postoperative complications, decreases immunological risk and accelerates functional recovery
Published Version
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