Modified Deep Anterior Lamellar Keratoplasty Technique to Rescue Failed Penetrating Keratoplasty

Abstract

Purpose To describe a modified deep anterior lamellar keratoplasty (DALK) technique to rescue failed penetrating keratoplasty (PK) grafts and report its results. Patients and Methods Retrospective, case-series analysis of patients who underwent modified DALK to rescue failed corneal grafts after PK was included. Every patient had corneal graft failure (GF) diagnosis due to anterior corneal (epithelium, Bowman’s, and stroma layers) or refraction disorders uncorrectable with conservative management. The main objective of the surgery and primary outcome of the study was the improvement of corrected distance visual acuity (CDVA). The study’s secondary outcome was the frequency of intra- and postoperative complications. Results This series included four eyes from three patients with a mean age of 57.7 years (range: 51–63 years). Mean follow-up of patients was thirteen months (range: 12–15 months). During follow-up, continuous improvement of corneal transparency and CDVA was observed in every patient. The only intraoperative complication reported was a peripheric DM microperforations of previous graft–host junction in two eyes. No signs of double anterior chamber, endothelial failure, GF, glaucoma, or other side effects were reported. Conclusion Our results suggest that modified DALK in patients with GF after PK, preserving a healthy endothelium, is surgically feasible. However, further studies are needed to compare this procedure to PK and other DALK technique variations.

High Astigmatism After Conventional Diameter Deep Anterior Lamellar Keratoplasty in Keratoconus Can Be Successfully Managed With Repeat Wide Diameter Deep Anterior Lamellar Keratoplasty

“…Repeat keratoplasty in the management of high astigmatism after keratoplasty has been previously described, although largely in eyes that have previously undergone PK rather than DALK. DALK after PK [24][25][26][27] was initially described by Lake et al in keratoconic patients with host rim thinning and ectasia after PK. A wide diameter trephination was used (range 9.25-10.5 mm) to include the peripheral residual ectasia, with subsequent manual dissection of the deep stroma.…”