Performing DALK complicated by Descemet's membrane macroperforation in keratoconus without conversion to penetrating keratoplasty: a case report
V. N. Serdiuk ¹, N. G. Klopotskaya ¹, S. B. Ustimenko ², Ye. N. Maidenko ², Ye. B. Storozhenko ², V. V. Tikhomirova ²
1 Dnipro State Medical University; Dnipro (Ukraine)
2 Dnipropetrovsk Regional Clinical Ophthalmological Hospital; Dnipro (Ukraine)
Serdiuk VN., Klopotskaya NG., Ustimenko SB., Maidenko YeN, Storozhenko YeB, Tikhomirova VV. Performing DALK complicated by Descemet's membrane macroperforation in keratoconus without conversion to penetrating keratoplasty: a case report http://doi.org/10.31288/oftalmolzh202225456
We report a case of successful deep anterior lamellar keratoplasty (DALK) for kearatoconus in the presence of intraoperative Descemet's membrane (DM) macroperforation in a 10-year boy. Intraoperative optical coherence tomography–guided femtosecond laser-assisted DM separation from the periphery to the center facilitated keeping the anterior chamber angle open and avoiding a subsequent increase in intraocular pressure. In addition, the size of the graft was made 0.4 mm larger that the size of the trephination hole, which enabled fitting of the graft margins and trephination margins, whereas precise deep femtosecond laser corneal dissection enabled (a) preventing a shock wave effect from the laser pulses and (b) DM adherence to the stroma of the graft. At 5 months after surgery, uncorrected visual acuity (UCVA) was 0.5; keratometry values OD were R1, 7.67 mm; К1, 44.0 D; R2, 7.30 mm; К2, 46.2 D; Rm, 7.48 mm; Km, 45.1 D; and Astig, 2.2 D. Anterior chamber angle was 41.4º. The DM adhered well to the donor stroma, the DM defect was practically not visualized on imaging, and endothelial cell density was 2719 cells/mm2 in the operated eye. At 7 months after surgery, the patient’s UCVA was 0.6 OD and corrected visual acuity with a spherical equivalent of +3.0 D was 0.9.
Keywords: deep anterior lamellar keratoplasty, Descemet's membrane macroperforation
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1.Hashem AN, Tolees SS, Samir A. Novel technique for the management of macroperforation during deep anterior lamellar keratoplasty. Clin Ophthalm. 2019 Oct 23;13:2075-2080.
2.Huang OS, Htoon HM, Chan AM, et al. Incidence and outcomes of intraoperative Descemet membrane perforations during deep anterior lamellar keratoplasty. Am J Ophthalmol. 2019 Mar;199:9-18.
3.Janiszewska-Bil D, Czarnota-Nowakowska B, Krysik K, et al. Comparison of long-term outcomes of the lamellar and penetrating keratoplasty approaches in patients with keratoconus. J Clin Med. 2021 May 29;10(11):2421.
4.Kodavoor SK, Deb B, Ramamurthy D. Outcome of deep anterior lamellar keratoplasty patients with intraoperative Descemet’s membrane perforation: A retrospective cross-sectional study. Ind J Ophthalm. 2018 Nov;66(11):1574-1579.
5.Nanavaty MA, Vijjan KS, Yvon C. Deep anterior lamellar keratoplasty: a surgeon's guide. J Current Ophthalmol. 2018 Jul 10;30(4):297-310.