Deep anterior lamellar keratoplasty: all the ruptures can be fixed

Session Details

Session Title: Cornea Surgical I

Session Date/Time: Monday 12/09/2016 | 08:00-10:30

Paper Time: 10:24

Venue: Hall C1

First Author: : E.Sarnicola ITALY

Co Author(s): :    C. Sarnicola   F. Sabatino   V. Sarnicola              

Abstract Details

Purpose:

To report outcomes of our experience in dealing with DM rupture during DALK procedure

Setting:

Ambulatorio di Chirurgia Oculare Santa Lucia, and Misericordia Hospital, Grosseto, Italy

Methods:

Retrospective evaluation of 1084 eyes of 908 patients, with stromal diseases and healthy endothelium, that have undergone DALK surgery between 2002 and 2013. Frequency, type and site of DM ruptures were reported for dDALK and pdDALK cases. Foundamental rules in fixing DM ruptures were described. Frequency of rebubbling, double chamber and pupillary block were reported. Expedients and different techniques to manage DM ruptures in special cases (excessive trephination, disparity of curvature between donor and recipient and DM disinsertion) were also described.

Results:

Ninety-one DM ruptures were recorded. Ruptures were more frequent in peripherally and in predescemetic-DALK. Seventy-four cases resulted repaired at 1st day post-op. Double anterior chamber occurred in 16cases. Ten cases were managed with single rebubbling, and 3 cases with 2rebubbling. In the remainder 3cases, repeated rebubbling weren’t able to resolve the double chamber because of the donor-recipient disparity of curvature. A full thickness subtotal circular cut of the recipient bed resolved the double chamber in 2 cases. In one case, the disparity of curvature was managed performing a total circular cut of the recipient bed, and gluing this selfendothelial-graft to the donor. Excessive corneal trephination occurred in one case and it was repaired too. No PK conversion was recorded.

Conclusions:

DM rupture is the most common complication during DALK procedure, even in expert hands. In our experience all kinds DM ruptures were repaired. The ability to repair DM ruptures improves when the surgeon gradually become more expert.

Financial Disclosure:

NONE