Rupture Pressure of the Posterior Lamella Obtained During Big-Bubble Deep Anterior Lamellar Keratoplasty

McKee, Hamish D.; Barua, Ankur; Brahma, Arun; Jhanji, Vishal; Carley, Fiona

doi:10.1097/ico.0b013e31823f8e1b

Cited by 9 publications

(4 citation statements)

References 11 publications

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“…As for the direct effect, to our knowledge, a trabeculoDescemet membrane hole directly caused by a big air bubble has never been reported in NPGS, and a recent study on the structurally similar posterior lamella obtained during the bigbubble deep anterior lamellar keratoplasty showed good resistance to high pressures. 36 As for the indirect one, substantial amounts of air (eg, the 80% air bubble usually left in place after our isolated DSAEK) might push the iris and the innermost trabecular layers toward the adjacent juxtacanalicular trabeculum and the inner wall of the Schlemm canal to reduce the aqueous percolation during the DS phase of peeling. As a consequence, there might be a clinical misinterpretation of the real trabecular aqueous egress and the actual depth of the dissection, leading to intraoperative iatrogenic trabeculo-Descemet membrane holes.…”

Section: Discussionmentioning

confidence: 99%

Combined Deep Sclerectomy and Descemet Stripping Automated Endothelial Keratoplasty

Vaiano

Salgarello

Giudiceandrea

et al. 2014

Cornea

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Section: Discussionmentioning

confidence: 99%

Combined Deep Sclerectomy and Descemet Stripping Automated Endothelial Keratoplasty

Vaiano

Salgarello

Giudiceandrea

et al. 2014

Cornea

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“… 16 All DALK procedures were performed using Anwar’s big-bubble technique, 17 – 19 with the aim to obtain a type 1 big-bubble. 9 …”

Section: Methodsmentioning

confidence: 99%

“… 8 Structural integrity is preserved, thereby reducing the risk of traumatic graft dehiscence. 9 One concern of this technique, however, has been the loss of best corrected visual acuity (BCVA), thought to be due to the interface between the donor and recipient tissue. 10 …”

Section: Introductionmentioning

confidence: 99%

Corneal clarity measurements in patients with keratoconus undergoing either penetrating or deep anterior lamellar keratoplasty

Alzahrani

Dardin

Carley

et al. 2018

OPTH

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PurposeTo compare the corneal clarity measurement between penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) in patients with keratoconus, using densitometry software for the Oculus Pentacam.MethodsA retrospective comparative study was carried out at Manchester Royal Eye Hospital. Data were collected 12–18 months after corneal transplantation for keratoconus, including postoperative corneal densitometry, best corrected visual acuity (BCVA), central corneal thickness (CCT), and other relevant clinical details.ResultsAnalysis of 37 keratoconus eyes from 36 patients found there was a significantly higher corneal densitometry measurement after DALK than PK. This was predominantly in the posterior layer of the concentric zone 0–2 mm of the cornea (P=0.0004). A significant correlation was found between postoperative BCVA and corneal densitometry in DALK groups at full thickness (P=0.03). This correlation was seen in the central 0–2 mm (P=0.03) and posterior 0–2 mm (P=0.04) zones. In addition, within the DALK group, a correlation was found between central corneal thickness and densitometry at full thickness 2–6 mm (P=0.007), central 0–2 (P=0.04), central 2–6 mm (P=0.01), and at posterior 2–6 mm (P=0.01) zones.ConclusionThis study showed that corneal densitometry measurement differs depending on the type of corneal transplantation used to treat keratoconus patients. Densitometry may have an important role to play in the final BCVA achieved by patients undergoing corneal transplantation for keratoconus. Analysis of Oculus Pentacam images provides an objective evaluation to monitor the cornea status after the surgery.

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“…Type 2 bubble is fragile because the tough stromal tissue does not cover the DM. For this reason, when type 2 bubble forms, DM bearing is a delicate phase of the surgery as macro perforations may be inadvertently induced, requiring conversion to PK [5,15].…”

Section: Tip #7 Management Of Type 2 Bubblementioning

confidence: 99%

Surgical Tips for Improving Success Rate of Deep Anterior Lamellar Keratoplasty in Keratoconus

Rossi¹,

Scorcia²,

Borselli³

et al. 2023

OBM Transplant

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This article aims to provide some personal surgical tips to increase the success rate of deep anterior lamellar keratoplasty (DALK), a very advantageous yet complex procedure for treating keratoconus. The most troublesome surgical step is obtaining a successful pneumatic dissection of the deep stromal tissue, allowing the exposure of a deep cleavage plane. The following tips may aid the trainee surgeon in mastering this step, among others: performing a deep trephination, using intraoperative anterior segment optical coherence tomography and/or femtosecond laser, exploiting the red reflex after pupil dilation, using the ophthalmic viscoelastic device in case of bubble formation failure. Approaches for reducing postoperative astigmatism are employing large-diameter grafts and using intraoperative keratoscopy with digital ring analysis. In conclusion, different tips can shorten the DALK learning curve and help to obtain better results from this surgery. Standardizing this surgical technique is paramount to reduce "human errors" and broaden its range of applicability.

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Rupture Pressure of the Posterior Lamella Obtained During Big-Bubble Deep Anterior Lamellar Keratoplasty

Abstract: The posterior lamella of big-bubble DALK probably confers significant structural integrity on the globe.

Cited by 9 publications

References 11 publications

Combined Deep Sclerectomy and Descemet Stripping Automated Endothelial Keratoplasty

Combined Deep Sclerectomy and Descemet Stripping Automated Endothelial Keratoplasty

Corneal clarity measurements in patients with keratoconus undergoing either penetrating or deep anterior lamellar keratoplasty

Surgical Tips for Improving Success Rate of Deep Anterior Lamellar Keratoplasty in Keratoconus

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