Clinical outcomes of deep anterior lamellar keratoplasty with Descemet baring limited to the central 6 mm

Session Details

Session Title: Cornea Surgical I

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

Paper Time: 10:12

Venue: Hall C1

First Author: : C.Bovone ITALY

Co Author(s): :    S. Gutfreund   S. Graffi   P. Leon   B. Filipovic Ricci   Y. Nahum   M. Busin     

Abstract Details

Purpose:

To report the outcomes of a modified technique for deep anterior lamellar keratoplasty (DALK) employing anair injection within 2 mm inside a deep trephination and transplantation of a donor lamella after baring Descemet membrane only in the central 6 mm of the recipient bed

Setting:

Villa Igea Private Hospital Forlì, Italy

Methods:

A standardized surgical technique wasperformed in 290 eyes with different indications: Keratoconus(KC) without scar(Group 1); KC with scar/hydrops(Group 2); non-scarred corneas other than KC(Group 3), and scarred corneas other than KC(Group 4). The procedure included: 9 mm trephination intended to a depth within 100 μm from the endothelial surface (based on the thinnest AS-OCT measurement at this site); injection of air through a cannula advanced 1-2mm centripetally from the bottom of the trephination; baring of the central 6 mm; transplantation of a 9mm donor anterior lamella. Best corrected visual acuity (BCVA),refraction and complications were recorded for each group.

Results:

Two-hundred ninety eyes of 290 patients were included in the study. Mean follow-up time was 14.5±3.7 (range 12-24)months. Pneumatic dissection succeeded in 81/94 eyes (86.2%); 49/101 (48.5%); 33/43 (76.7%) and 30/52 (57.7%) in group1, 2, 3, and 4 respectively. Manual dissection was performed in 57/290 (19.6%). Conversion to mushroom keratoplasty was necessary in 40 cases (13.8%). At the last postoperative follow-up visit, mean BCVA was 20/25(0.1±0.70 logMAR), 20/23(0.08±0.69 logMAR); 20/35 (0.24±0.51 logMAR) and 20/25(0.09±0.10 logMAR) in group1, 2, 3, and 4 respectively. After complete suture removal, refractive astigmatism was <4.5D in 76/98 eyes (77.5%)and >6D in 7/98 eyes (7.1 %).

Conclusions:

A large DALK with Descemet baring limited to a central zone, 6 mm in diameter, optimizes visual outcomes and postoperative refraction, while simplifying the surgical procedure particularly in eyes with scars, neovascularization and/or poor visualization of the anterior chamber.

Financial Disclosure:

... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented