Incidence and Outcomes of Intraoperative Descemet Membrane Perforations During Deep Anterior Lamellar Keratoplasty

Huang, Olivia S.; Htoon, Hla Myint; Chan, Amy; Tan, Donald; Mehta, Jodhbir S.

doi:10.1016/j.ajo.2018.10.026

Cited by 42 publications

(32 citation statements)

References 29 publications

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“…The successful use of nylon sutures to repair large DM ruptures in DALK has been described by Shimmura and Tsubota in 2006. 16,17 However, we found only one other case report that has described a successful management of this specific complication, a large DM rupture occurring at the time of the trephination. Zarei-Ghanavati and Zarei-Ghanavati performed a small BB that was carefully and slowly enlarged with ophthalmic viscoelastic device (OVD).…”

Section: Discussionmentioning

confidence: 90%

Manual deep anterior lamellar keratoplasty after partial unintentional full-thickness trephination

Sarnicola¹,

Sarnicola²,

Cheung

et al. 2020

European Journal of Ophthalmology

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Purpose: The aim of this study was to describe a surgical technique to perform deep anterior lamellar keratoplasty (DALK) despite inadvertent full thickness trephination in one quadrant. Methods: Case report of a 19-year-old boy who underwent DALK for visually significant post-infectious stromal scar in his left eye. An unintentional full thickness trephination occurred in the upper-nasal quadrant at the beginning of the surgery. After suturing the perforated area, manual DALK was performed, and an air bubble was left in the anterior chamber. Evaluated outcomes included best spectacle corrected visual acuity (BSCVA), residual recipient bed thickness, endothelial cell count (ECC), graft clarity, rejection, and presence/absence of double anterior chamber. Results: The surgery was completed without any further complications. No double anterior chamber or Urrets–Zavalia syndrome was observed on the first postoperative day. Mean residual recipient bed thickness was 72 μm and regular. ECC was 2446 cell/mm2. BSCVA at 18 months of follow-up was 0.9. There were no episodes of rejection, and the graft remained clear at the last follow-up (4 years). Conclusion: Inadvertent partial full thickness trephination of the recipient cornea is a largely preventable but possible complication during DALK. Penetrating keratoplasty conversion can be avoided by performing a manual dissection DALK.

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Section: Discussionmentioning

confidence: 90%

Manual deep anterior lamellar keratoplasty after partial unintentional full-thickness trephination

Sarnicola¹,

Sarnicola²,

Cheung

et al. 2020

European Journal of Ophthalmology

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“…Microperforation was defined as a small perforation that did not lead to consistent anterior chamber collapse, as compared to a macroperforation, in which a sizeable tear or gap in DM (>0.5 mm) resulted in persistent, complete collapse of the anterior chamber despite the use of air or balanced salt solution to reform the anterior chamber. [7] Postoperative data collection included BCVA, refraction, graft clarity, immediate or late DM detachment, and any possible complications. An anterior-segment consultant at KKESH performed all the surgeries using the “Big Bubble technique”[5] or manual layer-by-layer dissection.…”

Section: Methodsmentioning

confidence: 99%

“…[5] DM perforation is a major complication of DALK which has been reported to range from 4% to 39%. [678] Although DM perforation warrants conversion to PK, several techniques have been suggested to manage intraoperative DM perforation. Successful management of DM perforation reduces the rate of conversion to PK and hence preserves the advantages of DALK over PK.…”

Section: Introductionmentioning

confidence: 99%

Use of fibrin glue in the management of Descemet membrane perforation during deep anterior lamellar keratoplasty

Alharbi

AlAmeer

2019

Middle East Afr J Ophthalmol

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PURPOSE:To describe the use of fibrin glue to seal Descemet membrane (DM) microperforation and macroperforation during deep anterior lamellar keratoplasty (DALK).METHODS:A retrospective chart review was performed on patients who had DM perforation managed by fibrin glue during DALK at King Khaled Eye Specialist Hospital (KKESH) between June 2014 and February 2019.RESULTS:One thousand two hundred and eighty-eight DALK surgeries were performed at KKESH during the study period. Fibrin glue was used to seal DM perforations in four cases of DALK for keratoconus.CONCLUSION:Fibrin glue is an effective method to seal DM microperforations and macroperforations during DALK, which reduces the rate of conversion to penetrating keratoplasty (PK), preserving the advantage of DALK over PK.

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“…These measures include suturing of perforation, intraoperative stromal patching, use of fibrin glue, and conversion to a manual dissection technique. 25 Perforations that occur during trephination is closed by tight sutures, followed by manual dissection of the corneal stroma. Afterward, donor graft is fixed to the recipient bed using full-thickness sutures in the site of perforation.…”

Section: Complications Associated With Donor–recipient Interfacementioning

confidence: 99%

Approaches toward enhancing survival probability following deep anterior lamellar keratoplasty

Feizi

Azari

2020

Ophthalmol Eye Dis

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The greatest advantage of deep anterior lamellar keratoplasty over full-thickness corneal transplantation is the elimination of graft failure caused by endothelial rejection. Despite this advantage, a deep anterior lamellar keratoplasty graft can fail because of several factors, such as complications related to the donor–recipient interface, graft epithelial abnormalities, graft vascularization, stromal graft rejection, and recurrence of herpetic keratitis. Increased deep anterior lamellar keratoplasty graft survival is mainly built upon optimization of the ocular surface to provide a hospitable environment for the graft. Any predisposing factors for graft epithelial abnormalities, corneal neovascularization, and preexisting vernal keratoconjunctivitis should be identified and treated preoperatively. Prompt recognition and appropriate treatment of interface-related complications and stromal graft rejection usually result in good anatomic outcomes, with no detrimental effects on vision.

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Incidence and Outcomes of Intraoperative Descemet Membrane Perforations During Deep Anterior Lamellar Keratoplasty

Cited by 42 publications

References 29 publications

Manual deep anterior lamellar keratoplasty after partial unintentional full-thickness trephination

Manual deep anterior lamellar keratoplasty after partial unintentional full-thickness trephination

Use of fibrin glue in the management of Descemet membrane perforation during deep anterior lamellar keratoplasty

Approaches toward enhancing survival probability following deep anterior lamellar keratoplasty

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