Triple chamber: a clinical rarity after deep anterior lamellar keratoplasty and role of optical coherence tomography in management

Abstract

To report a case demonstrating triple chamber following deep anterior lamellar keratoplasty (DALK) and its successful intra-operative optical coherence tomography-guided management. Case report of a young male with macular corneal dystrophy, who underwent DALK in his left eye by Big-Bubble technique. The surgery was uneventful. On the first post-operative day, triple chamber was observed and followed-up with serial clinical photography and anterior segment optical coherence tomography. Due to decrease in graft clarity and increase in volume of the two extra chambers, interface drainage along with descemetopexy was undertaken 4days later. The compartments constituting the triple chamber were those in-between the donor tissue and host pre-Descemet layer (Dua's layer), the latter and host Descemet membrane and the true anterior chamber. Presence of viscoelastic in the interface was identified as the cause. Microscope integrated optical coherence tomography (MiOCT) guided drainage followed by intracameral air tamponade ensured near total disappearance of the two extra chambers at the end of surgery. Examination on the next day confirmed complete apposition of the graft and host. To the best of our knowledge, this is a unique demonstration of Dua's layer in vivo by slit lamp biomicroscopy and description of MiOCT guided management of triple chamber.