Abstract
Aim: To analyse the outcome of Deep anterior lamellar keratoplasty (DALK) in cases of pre-existing DM (Descemet membrane) tear. Method: 14 eyes with pre-existing perforation (4 eyes with advanced keratoconus post collagen crosslinking and post Toric implantable collamer lens explantation and 10 eyes with post healed hydrops) who underwent DALK were included. Manual layer by layer dissection by a special technique was employed. Results: Minimum follow up-1 year. All patients had good post-operative results with mean UCVA preoperative and postoperative value of 1.35±0.25 LogMAR and 0.68 ± 0.19 LogMAR respectively with ‘p’ value of 0.00001 which was significant. Mean astigmatism preoperative and postoperative was found to be 4.82±1.76D and 2.66±0.7D and ‘p’ value was significant (p=0.00042). Mean endothelial count preoperative and postoperative was 2479.18±239.42cells/cm<sup>2</sup> and 2238.45±218.49cell/cm<sup>2</sup> with percentage reduction of 9.6% at 1 year. Two eyes among them had postoperative double anterior chamber and two eyes had wrinkling of DM due to the advanced nature of KC. Conclusion: DALK can be successful in patients with pre-existing DM perforation if careful precautions are taken. Also layer by layer technique with a centripetal dissection is preferred in such cases to prevent intraoperative scar extension.
Highlights
Patients with keratoconus can present with acute painful condition known as acute hydrops due to rupture of DM (Descemet membrane) and aqueous entry into corneal stroma and reduction in visual acuity
After the popularization of Deep anterior lamellar keratoplasty (DALK) (Deep Anterior Lamellar Keratoplasty), many surgeons prefer it over penetrating keratoplasty (PK) in selected cases for its advantages.[2,3,4]
Performing DALK in a previously perforated DM is quite challenging and the authors here have described a technique for successful DALK in pre-existing DM perforation post hydrops and in cases where DM has been perforated for any ocular surgeries with poor outcome
Summary
Patients with keratoconus can present with acute painful condition known as acute hydrops due to rupture of DM (Descemet membrane) and aqueous entry into corneal stroma and reduction in visual acuity. Incidence range from 2.6 to 2.8%.[1] Post hydrops, the inflammation, edema and pain subsides but all patients end up with irregular astigmatism which requires surgical correction. After the popularization of DALK (Deep Anterior Lamellar Keratoplasty), many surgeons prefer it over PK in selected cases for its advantages.[2,3,4] performing DALK in a previously perforated DM is quite challenging and the authors here have described a technique for successful DALK in pre-existing DM perforation post hydrops and in cases where DM has been perforated for any ocular surgeries (phakic intraocular lens) with poor outcome
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: International Journal of Ophthalmology & Visual Science
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
