Deep Anterior Lamellar Corneal Dissection To Improve Visualization During Vitreoretinal Surgery

Merchant, Kinnar; Yewande, Olaoye; Morgan, Stephen J.; Steel, David

doi:10.1097/iae.0b013e31826a6959

Cited by 4 publications

(4 citation statements)

References 9 publications

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“…However, for the eyes associated with retinal detachment, the appropriate strategy is to perform an emergent vitrectomy firstly and then an elective corneal transplantation follows after retinal reattachment due to the lower success rate of corneal transplantation combined with vitrectomy. Successful DALK combined with vitrectomy was reported in previous case with corneal decompensation and retinal detachment [6]. A similar result was demonstrated in our case 2.…”

Section: Discussionsupporting

confidence: 91%

“…Vitreoretinal surgery in the patients with coexisting corneal opacity is a challenge for retinal surgeons. For cases with dense corneal opacification which impedes the visualization for vitreoretinal intervention, the main solutions include traditional use of penetrating keratoplasty (PKP), ophthalmic endoscope and temporary keratoprosthesis (TKP) [ 1 – 4 ], or recent deep anterior lamellar keratoplasty (DALK) on only a few occasions [ 5 , 6 ]. The main advantages of DALK are that it decreases the risks of endothelial rejection and decompensation, and eliminates the complications associated with open-sky procedure [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…The main advantages of DALK are that it decreases the risks of endothelial rejection and decompensation, and eliminates the complications associated with open-sky procedure [ 7 ]. This method was first used in a case with hematocornea and posttraumatic retinal detachment in 2001 [ 5 ], and then applied to one patient with bullous keratopathy and retinal detachment in 2012 [ 6 ], In this technique, the opaque deep corneal lamella was removed before vitrectomy and replaced with a fresh corneal lamella at the end of surgery.…”

Section: Introductionmentioning

confidence: 99%

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Modified deep anterior lamellar dissection for corneal opacity during vitrectomy: case reports

Zhang

Zhou

et al. 2020

BMC Ophthalmol

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Background: To introduce a modified deep anterior lamellar dissection technique to improve visibility during surgery for vitreoretinal diseases with coexisting corneal opacity. Case presentation: Two patients with retinal detachment and coexisting corneal blood staining or corneal decompensation underwent modified deep anterior lamellar dissections followed by vitrectomy. The modified deep anterior lamellar dissection techniques, unlike the dissection and removal of corneal lamellar in a typical deep anterior lamellar keratoplasty, included the creation and preservation of a deep lamellar corneal flap, the retroillumination to visualize and easily remove the remaining opaque stroma on the Descemet membrane, and the big air bubble technique in the eye with endothelial decompensation. The patient's own cornea flap was sutured back after vitrectomy was done. The modified dissection techniques provided adequate fundus view during vitrectomy while removing as less corneal tissue as possible and decreasing the surgical complications and the requirement of a fresh cornea. Postoperatively, in case 1, the corneal blood staining was gradually absorbed and the vision improved from light perception to counting fingers. In case 2, even though the cornea remained cloudy and the vision was poor, the cornea endothelial decompensation was stable and asymptomatic. Both retinas were attached after silicone oil removal at 6-month follow-up. Conclusions: This modified and limited deep anterior lamellar corneal dissection procedure appears to be a useful alternative to penetrating keratoplasty, ophthalmic endoscope and temporary keratoprosthesis during the vitrectomy with coexisting corneal opacity.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Modified deep anterior lamellar dissection for corneal opacity during vitrectomy: case reports

Zhang

Zhou

et al. 2020

BMC Ophthalmol

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“…In cases of patients with combined lens opacity, cataract surgery is often performed alongside vitreoretinal surgery to restore optical clarity. However, in severe corneal opacities such as severe corneal trauma, corneal blood staining and infectious endophthalmitis, temporary keratoprosthesis, 1,2 deep lamellar keratoplasty, [3][4][5] or intraocular endoscopy systems 6,7 are often required for vitreoretinal surgery. The opaque corneal tissue is removed using a corneal trephine, followed by suturing of the temporary keratoprosthesis.…”

mentioning

confidence: 99%

A Novel Embedded-style Corneal Contact Lens: For Emergency Vitreoretinal Surgery in Patients with Severe Corneal Opacities

Liu,

Lei,

Guo

et al. 2024

Retina

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Novel Application of Deep Anterior Lamellar Keratoplasty for Retinal Detachment Repair in Totally Opaque Cornea Secondary to Aniridia

Simpson,

Al-Hayouti,

Ramaesh

et al. 2024

RETINAL Cases &Amp; Brief Reports

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Purpose: We present a novel approach for managing retinal detachment in a patient with aniridia related corneal scarring precluding fundal view via a deep anterior lamellar keratoplasty. Methods: A 30-year-old female patient who had bilaterally opaque cornea, due to advanced aniridia related keratopathy presented with, experiencing flashing of light in her right eye. Examination of the retinal fundus was not possible due to the dense corneal scarring and underlying cataract. A superior bullous macula off retinal detachment was diagnosed on ultrasonography. Visual acuity at presentation was hand motions. The corneal scarring extended to the mid to deep stroma. We performed a deep anterior lamellar dissection of the opacified corneal stroma, that allowed clear visualisation of a dense cataract. The cataract was removed by phacoemulsification and IOL inserted. This allowed to proceed with repair of retinal detachment, through pars plana approach. The surgery was completed by a donor deep lamellar keratoplasty. Results: This achieved a good fundal view to proceed with phacovitrectomy visualised through the residual corneal layers. Uneventful pars plana vitrectomy, cryotherapy and SF6 gas were performed to reattach the retina. Post-operatively the graft remains clear at 6 months with a visual acuity of 20/160 in the right eye, a level of vision the patient had not experienced for decades. Conclusion: Deep anterior lamellar keratoplasty offered an alternative to temporary keratoprosthesis to achieve a clear view of the retinal fundus and perform pars plana vitrectomy and repair of the retinal detachment.

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Deep Anterior Lamellar Corneal Dissection To Improve Visualization During Vitreoretinal Surgery

Cited by 4 publications

References 9 publications

Modified deep anterior lamellar dissection for corneal opacity during vitrectomy: case reports

Modified deep anterior lamellar dissection for corneal opacity during vitrectomy: case reports

A Novel Embedded-style Corneal Contact Lens: For Emergency Vitreoretinal Surgery in Patients with Severe Corneal Opacities

Novel Application of Deep Anterior Lamellar Keratoplasty for Retinal Detachment Repair in Totally Opaque Cornea Secondary to Aniridia

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