Small-Bubble Deep Anterior Lamellar Keratoplasty Technique

Scorcia, Vincenzo; Beltz, Jacqueline; Busin, Massimo

doi:10.1001/jamaophthalmol.2014.2756

Cited by 12 publications

(8 citation statements)

References 11 publications

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“…Anterior lamellar keratoplasty (ALK) was performed using either pneumatic or microkeratome-assisted dissection 10 11. DSAEK and ultrathin DSAEK were also performed in a standardised fashion following the technique described elsewhere 12.…”

Section: Methodsmentioning

confidence: 99%

Prevalence of guttae in the graft following corneal transplantation

et al. 2015

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Section: Methodsmentioning

confidence: 99%

Prevalence of guttae in the graft following corneal transplantation

et al. 2015

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“…Despite the increased CDVA and low number of complications, they later reported that preventing the bubble from expanding into the PK wound was not always possible, requiring conversion to PK. 13,14 When we compare our results to these studies, we also report good visual outcomes, a more controlled corneal dissection and wound construction, and absence of double anterior chamber or conversion to PK events.…”

Section: Discussionmentioning

confidence: 52%

“…10,11 However, there are few reports regarding the use of deep anterior lamellar keratoplasty (DALK) in patients where GF after PK is due to conditions that affect anterior layers of the cornea and spare Descemet's membrane (DM) and endothelium. [12][13][14][15] In light of this, the purpose of our study is to describe a modified DALK technique to rescue failed PK grafts and report its results through a case series of patients.…”

Section: Introductionmentioning

confidence: 99%

Modified Deep Anterior Lamellar Keratoplasty Technique to Rescue Failed Penetrating Keratoplasty

Lisa¹,

Soares²,

Fernández-Vega-Cueto³

et al. 2022

OPTH

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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.

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“…In previous literature, low success rate to expose DM was observed in some corneal pathology such as scar following bacterial keratitis;[ 15 ] and complications such as DM rupture were likely to occur when performing pneumatic dissection (big-bubble technique) in corneas with extensive scar. [ 24 ] Despite this fact, after corneal stroma is inflated with air and becomes foam-like, it appears that the residual stromal tissue could be dissected easier. Such air-assisted manual DALK was first reported by Balestrazzi et al .…”

Section: Discussionmentioning

confidence: 99%

Surgical outcome of deep anterior lamellar keratoplasty with air-assisted manual dissection for corneas with previous inflammation or fibrosis

Chen

et al. 2017

Taiwan J Ophthalmol

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PURPOSE:To report our experience in air-assisted manual dissection deep anterior lamellar keratoplasty (DALK) for the treatment of corneal scar with previous inflammation and fibrosis.MATERIALS AND METHODS:We retrospectively reviewed the medical history of 21 patients (male:female = 13:8 mean age 41.9 years old) with corneal pathology from previous infection and inflammation. Trephination diameter ranged from 7.0 to 8.0 mm, and the graft was oversized by 0.25–0.50 mm. Debulking technique was performed to expose Descemet's membrane after filling stroma with air. Starting from postoperative 3 months, selective suture removal was performed to reduce corneal astigmatism.RESULTS:The mean follow-up period was 59.9 ± 19.8 (20–96) months. Intraoperative microperforation occurred in 2 eyes (9.5%); however, there was no shift to penetrating keratoplasty. Air-bubble tamponade was performed in 7 eyes (33.3%) for postoperative gapping of the graft. There were 2 failed grafts (9.5%) due to corneal ulcer while all the other grafts remained clear throughout follow-up. The mean preoperative best-corrected visual acuity (BCVA) was 1.84 ± 0.66 logMAR, which improved to 0.74 ± 0.63 (P < 0.01). The average sphere power was − 0.88 ± 3.88 diopter (D), average cylinder power 3.03 ± 1.46D, and average endothelial count 1877 ± 375 cells/mm2.CONCLUSION:In severe ocular surface diseases, big-bubble technique frequently failed to separate predescemtic plane; however, it effectively created air-filled stroma which was easier to remove. Although BCVA was suboptimal due to ocular surface disorders, graft survival and clarity rate is high, justifying the application of DALK in these cases.

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Small-Bubble Deep Anterior Lamellar Keratoplasty Technique

Cited by 12 publications

References 11 publications

Prevalence of guttae in the graft following corneal transplantation

Prevalence of guttae in the graft following corneal transplantation

Modified Deep Anterior Lamellar Keratoplasty Technique to Rescue Failed Penetrating Keratoplasty

Surgical outcome of deep anterior lamellar keratoplasty with air-assisted manual dissection for corneas with previous inflammation or fibrosis

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