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

Autor:	Goweida MB; Alexandria Main University Hospital, Alexandria, Egypt.; Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt., Mahmoud S; Alexandria Main University Hospital, Alexandria, Egypt.; Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt., Sobhy M; Alexandria Main University Hospital, Alexandria, Egypt.; Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt., Liu C; Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.; Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.; Tongdean Eye Clinic, Hove, United Kingdom.; Brighton and Sussex Medical School, Brighton, United Kingdom.
Jazyk:	angličtina
Zdroj:	Journal of current ophthalmology [J Curr Ophthalmol] 2021 Jul 05; Vol. 33 (2), pp. 171-176. Date of Electronic Publication: 2021 Jul 05 (Print Publication: 2021).
DOI:	10.4103/2452-2325.303199
Abstrakt:	Purpose: To evaluate the outcome of eyes with large Descemet's membrane (DM) perforation during deep anterior lamellar keratoplasty (DALK). Methods: A retrospective, interventional case series of 12 eyes with completed DALK, despite DM perforation larger than 4 mm in its widest dimension. The main outcome measures included graft clarity, endothelial cell density (ECD), corrected distance visual acuity (CDVA), and DM detachment. Results: The mean age of patients was 26.8 ± 11.4 years. Preoperative pathology included keratoconus ( n = 10), macular dystrophy ( n = 1), and postmicrobial keratitis corneal scar ( n = 1). The average size of DM perforation was 6.5 mm ± 1.3 mm. At the end of the follow-up period (median 15 months, range 6-53 months), the mean CDVA was 0.32 ± 0.09 logMAR and the mean ECD was 1830.8 ± 299.7 cells/mm 2 . Nine patients (75%) developed DM detachments postoperatively and was managed by intracameral air injection once in six eyes, and twice in three eyes. Other complications included persistent localized stromal edema at the site of DM defect in one eye and Urrets Zavalia syndrome in one eye. Conclusion: Completing DALK in eyes with large DM perforation provides good visual acuity, endothelial cell count and may be superior to penetrating keratoplasty regarding long-term graft survival if confirmed in future comparative studies. Competing Interests: There are no conflicts of interest. (Copyright: © 2021 Journal of Current Ophthalmology.)
Databáze:	MEDLINE
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