Avoiding big bubble complications: outcomes of layer-by-layer deep anterior lamellar keratoplasty in children

Elbaz, Uri; Kirwan, Caitriona; Shen, Carl; Ali, Asim

doi:10.1136/bjophthalmol-2017-310962

Cited by 22 publications

(27 citation statements)

References 28 publications

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“…On the other hand, in keratoconus with deep posterior scars, it probably would be wiser to perform manual dissection assisted by peroperative OCT, rather than taking the risk of perforation with the big bubble technique. Other dissection techniques such as Melles' method, manual dissection, hydrodissection, and viscodissection could be intended [ 37 – 39 ].…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Successful Type 1 Big Bubble during Deep Anterior Lamellar Keratoplasty

Borderie¹,

Touhami²,

Georgeon³

et al. 2018

Journal of Ophthalmology

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Objective Big bubble (BB)-deep anterior lamellar keratoplasty (DALK) has become the reference transplantation technique for corneal stromal disorders. Type 1 BB is the desired aspect but it is not constant. We aimed to determine the predictive factors of type 1 BB success. Methods Observational cohort study including 77 consecutive eyes of 77 patients undergoing DALK by one surgeon at a single reference center without any selection. Clinical and spectral domain optical coherence tomography data were collected pre- and postoperatively. Results Stromal scars were found in 91.8% of cases and were located in the anterior (90.9%), mid (67.5%), and posterior (36.4%) stroma. Type 1 BB (49.3% of cases) was significantly associated with the absence of scars in the posterior stroma, stage 1–3 keratoconus, and deep trephination. Among eyes with posterior scars, type 1 BB was associated with higher minimal corneal thickness, maximum-minimum corneal thickness < 220 μm, and diagnosis other than keratoconus. Eyes with type 1 BB featured significantly thinner residual stromal bed (22 ± 8 µm versus 61 ± 28 µm), thinner corneas at 12, 24, and 36 months, and better visual acuity at 12 months compared with eyes with no type 1 BB. Conversely, no significant differences between both groups were observed for graft survival, visual acuity at 24 and 36 months, and endothelial cell density at 12 and 36 months. Conclusion OCT assessment before DALK is useful for choosing trephination depth that should be as deep as possible and for looking for posterior scars. The BB technique may not be the most appropriate method in keratoconus with posterior scars. Follow-up data do not support the need for conversion to penetrating keratoplasty when type 1 BB cannot be obtained nor does it support the need for performing a penetrating keratoplasty as a first-choice procedure in eyes with posterior stromal scars.

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Section: Discussionmentioning

confidence: 99%

Predictive Factors for Successful Type 1 Big Bubble during Deep Anterior Lamellar Keratoplasty

Borderie¹,

Touhami²,

Georgeon³

et al. 2018

Journal of Ophthalmology

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“…Though successful structural rehabilitation may not translate to visual and functional recovery due to issues related to amblyopia. 67 …”

Section: Resultsmentioning

confidence: 99%

Deep anterior lamellar keratoplasty: A surgeon's guide

Nanavaty

Vijjan

Yvon

2018

Journal of Current Ophthalmology

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PurposeTo review and highlight important practical aspects of deep anterior lamellar keratoplasty (DALK) surgery and provide some useful tips for surgeons wishing to convert to this procedure from the conventional penetrating keratoplasty (PK) technique.MethodsIn this narrative review, the procedure of DALK is described in detail. Important pre, intra, and postoperative considerations are discussed with illustrative examples for better understanding. A comprehensive literature review was conducted in PubMed/Medline from January 1995 to July 2017 to identify original studies in English language regarding DALK. The primary endpoint of this review was the narrative description of surgical steps for DALK, its pitfalls, and management of common intraoperative complications.ResultsA standard DALK procedure can be successfully performed taking into consideration factors such as age, ophthalmic co-morbidities, status of the crystalline lens, retina, and intraocular pressure. Careful trephination and dissection of the host cornea employing appropriate technique (such as big bubble technique, manual dissection, visco-dissection, etc.) suitable for the specific case is important to achieve good postoperative outcomes. Prompt identification of intraoperative complications such as double bubble, micro and macroperforations, etc. are vital to change the management strategies.ConclusionAlthough there is a steep learning curve for DALK procedure, considering details and having insight into the management of intraoperative issues facilitates learning and reduces complication rates.

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“…Nonetheless 17.6% had intraoperative microperforation although none of them required conversion to PK. 22 DM detachments were seen in 7.6% (2/26) cases (Ashar et al) vs 0.05% (1/20) cases (Arora et al). 21 , 28 The majority of these occurred intraoperatively and were managed conservatively.…”

Section: Pediatric Lamellar Keratoplastymentioning

confidence: 96%

Current Perspectives on Corneal Transplantation (Part 2)

Wong¹,

S²,

Walkden³

2022

OPTH

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Disease of the cornea is the third leading cause of blindness worldwide. Corneal graft surgery is one of the most successful forms of solid organ transplantations in humans, with ever increasing developments in surgical technique. To date, approximately 4504 corneal transplants are performed in the UK each year. While full thickness transplantation was the most commonly performed keratoplasty over the last few decades, selective lamellar transplantation of the diseased layers of the cornea has been universally adopted. This comprehensive review aims to provide an updated synthesis on different types of corneal transplantations, their treatment outcomes, and the associated complications of each procedure both in adult and pediatric populations. In addition, we also present an up-to-date summary of the emerging therapeutic approaches that have the potential to reduce the demand for donor-dependent keratoplasty.

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Avoiding big bubble complications: outcomes of layer-by-layer deep anterior lamellar keratoplasty in children

Abstract: Manual dissection DALK is a safe procedure in children with stromal opacities. Despite successful structural rehabilitation, functional recovery is still suboptimal mostly due to amblyopia.

Cited by 22 publications

References 28 publications

Predictive Factors for Successful Type 1 Big Bubble during Deep Anterior Lamellar Keratoplasty

Predictive Factors for Successful Type 1 Big Bubble during Deep Anterior Lamellar Keratoplasty

Deep anterior lamellar keratoplasty: A surgeon's guide

Current Perspectives on Corneal Transplantation (Part 2)

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