Predictors of Bubble Formation and Type Obtained With Pneumatic Dissection During Deep Anterior Lamellar Keratoplasty in Keratoconus

Scorcia, Vincenzo; Giannaccare, Giuseppe; Lucisano, Andrea; Soda, Mauro; Scalzo, Giovanna Carnovale; Myerscough, James; Pellegrini, Marco; Verdoliva, Francesco; Piccoli, Gabriele; Bovone, Cristina; Busin, Massimo

doi:10.1016/j.ajo.2019.12.012

Cited by 34 publications

(22 citation statements)

References 28 publications

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“…In patients undergoing keratoplasty for severe KC with the presence of stromal scars, the AS-OCT analysis is crucial for the choice of the proper surgical planning [12][13][14]. Borderie and co-workers analyzed predictive factors for the formation and type of a big bubble (BB) during DALK and found that type 1 BB formation was significantly associated with the absence of scars in the posterior stroma (stages 1-3 of the Sandali classification); conversely, the presence of posterior scars represents a significant risk factor for type 2 BB formation [15]. In fact, it has been hypothesized that deep scarring may fuse the PDL to the posterior stroma or degrade the PDL itself, preventing type 1 BB formation owing to the direct air dispersion at the level of DM.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Amsler–Krumeich and Sandali Classifications for Staging Eyes with Keratoconus

et al. 2021

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Keratoconus (KC) is the most common corneal ectasia characterized by progressive corneal thinning, protrusion, and irregular astigmatism. The Amsler–Krumeich classification based on the analysis of corneal topography, corneal thickness, refraction and biomicroscopy is the most commonly used; recently, a new classification based on anterior segment Optical Coherence Tomography was introduced by Sandali and colleagues. Since there is no information about the possible agreement between these two classifications, the aim of this study is to compare the stratification of consecutive KC patients using the Amsler–Krumeich and Sandali classifications, and to further ascertain KC cases in which one classification is preferred over the other. Overall, 252 eyes of 137 patients (41.45 ± 16.93 years) were analyzed: in 156 eyes (61.9%), the Amsler and Sandali staging differed in one stage while in 75 cases (29.8%) it differed in two or more stages. In 222 eyes (88.1%), the Sandali staging was higher compared to the Amsler one. These results show that the two classifications are not fully interchangeable: the Amsler–Krumeich classification is more appropriate in identifying and longitudinally monitoring patients with early stages of KC, while the Sandali classification for the diagnosis and follow-up of patients with more advanced stages, particularly when a surgical planning has to be chosen.

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Section: Discussionmentioning

confidence: 99%

Comparison of Amsler–Krumeich and Sandali Classifications for Staging Eyes with Keratoconus

et al. 2021

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“…Interestingly, pneumatic dissection resulted in the formation of a type 1 bubble in all cases. The presence of PDL confers additional strength to the floor of the bubble and accounts for the absence of intraoperative and postoperative complications observed in this series despite the inclusion of eyes with more advanced stages of keratoconus [ 11 , 31 ]. Although the FSL settings used were originally developed for ICRS implantation, the modifications presented in this series could represent a major improvement in the DALK technique.…”

Section: Discussionmentioning

confidence: 99%

“…However, based on the 2019 statistical report of the Eye Bank Association of America [ 10 ], the general popularity of DALK has remained limited with only 11% of corneal transplants for keratoconus performed using DALK compared to 89% with PK. Though several techniques for DALK have been proposed [ 1 ], there has been a slow adoption among corneal surgeons, mainly due to technical challenges in achieving a smooth and regular graft-host interface compatible with optimal vision [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Preliminary Results of a Novel Standardized Technique of Femtosecond Laser-Assisted Deep Anterior Lamellar Keratoplasty for Keratoconus

Lucisano

Giannaccare

Pellegrini

et al. 2020

Journal of Ophthalmology

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Purpose. To evaluate the feasibility and the initial outcomes of a novel standardized surgical technique of femtosecond laser- (FSL-) assisted big-bubble deep anterior lamellar keratoplasty (BBDALK) for eyes with keratoconus. Methods. This prospective interventional case series included 11 consecutive FSL-assisted BBDALK procedures performed for the eyes with keratoconus from September 2019 to December 2019. The FSL was used to create (i) an intrastromal channel incision (1.7 mm in length, 4.6 mm in width, 80% depth, and cut energy of 1.70 μJ) and (ii) a 9.0 mm diameter circular lamellar side cut 65 μm above the endothelium (cut energy of 0.90 μJ) intersecting the intrastromal incision. In the operating room, a blunt dissector was used to open the intrastromal channel incision, through which a blunt spatula was inserted, tangentially advanced towards the center of the cornea, and replaced with a blunt cannula for pneumatic dissection. The subsequent surgical steps did not differ from the conventional technique. Main outcome measures were the success rate of pneumatic dissection and the percentage of intraoperative complications. Results. Eleven eyes of 11 patients (6 males and 5 females; mean age: 34.54 ± 13.23 years) underwent FSL-assisted DALK. Using the FSL, both corneal incisions (lamellar side cut and intrastromal channel incision) were successfully created in all cases without the need for repeat docking or additional dissection. Pneumatic dissection with type 1 bubble formation succeeded in all 11 eyes (100%). DALK surgery was completed uneventfully in all cases. Descemet membrane perforation did not occur in any case, and no procedure was converted to penetrating keratoplasty. Conclusion. Using standardized FSL parameters for both incision design and cut energy in BBDALK surgery, pneumatic dissection can be achieved in a very high rate of cases with minimal risk of intraoperative complications.

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“…Differently from type 1, the Type 2 Bubble is a large and very thin bubble beginning at the peripheral cornea and expanding very quickly towards the centre. It is located between Dua's layer [7] and Descemet's membrane and there is a higher risk of DM perforation because no protection is offered towards the DM [9][10][11][12][13].…”

Section: Pneumatic Stromal Delamination (Psd) and Bubble Typesmentioning

confidence: 99%

Donor-Recipient Crosslinking-Assisted Manual Deep Anterior Lamellar Keratoplasty: DRXL-DALK

Zagari¹,

Mazzotta

Zagari³

et al. 2021

Keratoconus

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Predictors of Bubble Formation and Type Obtained With Pneumatic Dissection During Deep Anterior Lamellar Keratoplasty in Keratoconus

Cited by 34 publications

References 28 publications

Comparison of Amsler–Krumeich and Sandali Classifications for Staging Eyes with Keratoconus

Comparison of Amsler–Krumeich and Sandali Classifications for Staging Eyes with Keratoconus

Preliminary Results of a Novel Standardized Technique of Femtosecond Laser-Assisted Deep Anterior Lamellar Keratoplasty for Keratoconus

Donor-Recipient Crosslinking-Assisted Manual Deep Anterior Lamellar Keratoplasty: DRXL-DALK

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