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.

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Purpose:To compare the functional and anatomical outcomes (in terms of graft uptake and rejection/failure) of deep anterior lamellar keratoplasty (DALK) in stromal corneal dystrophy (macular and granular).Methods:Sixteen eyes with macular corneal dystrophy (MCD; group A) and 10 eyes with granular corneal dystrophy (GCD; group B) underwent successful DALK by big bubble technique or layer-by-layer dissection.Results:Both groups showed significant improvement in their best-corrected visual acuity postoperatively (postoperative P value in MCD and GCD was 0.00001 and 0.0008, respectively) with no statistically significant differences between the two groups (P = 0.77) at 1 year. Postoperative endothelial count did not drop significantly in group A (MCD, P = 0.1553). Only in seven eyes preoperative endothelial count could be obtained (due to dense stromal corneal opacity), but there was a significant endothelial count difference between preoperative and postoperative count in group B (GCD, P = 0.0405) at the end of 1 year postoperatively which could be because of age and stage of disease (advanced granular dystrophy) and also because of small sample size of GCD compared with MCD. Intergroup comparison between the two groups showed no statistically significant difference (P = 0.6353) with good postoperative outcome in both groups.Conclusion:DALK can be successfully done in both groups and results are comparable. However, long-term outcomes on a large scale need to be further evaluated.

Background: 870 eyes of 855 patients with intumescent immature and total white cataract were enrolled in this retrospective clinical study (2013-2018). Methods: Through a side port using a 25 gauze round/flat tipped fine cannula connected to a 5ml syringe (after a nick being created by a regular 26 gauze cystitome) the free capsular flap was vacuumed by the tip of the 25 gauge cannula and suction pressure created by withdrawing the piston of the syringe and a controlled motion done to create a circular rhexis, without withdrawing the instrument from anterior chamber and aspirating liquefied cortex by the same cannula. All cases were done under peribulbar anesthesia. Results: A complete cannula vacuum continuous curvilinear capsulorhexis (CanVac-CCC) was achieved in 860 cases (98.85%) except eight cases (0.91%) which had anterior capsular rhexis extension and two cases (0.22%) which had also extended posterior capsular tear. Conclusion: Performing CanVac-CCC with our technique is safe and affordable and may be an alternative promising method to routine CCC by using 26 gauge cystitome, Utrata or microrhexis forceps.

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