Posters
Managing a case of late Descemet's membrane break in DALK
Poster Details
First Author: P. Garimoldi ITALY
Co Author(s): M. De Molfetta C. Azzolini
Abstract Details
Purpose:
To report an intraoperative management of a late Descemet's tear during DALK procedure.
Setting:
Ospedale Galmarini, Tradate - ASST dei Sette Laghi.
Università degli Studi dell'Insubria. Ospedale Macchi,Varese - ASST dei Sette Laghi
Methods:
An herpetic leucoma was treated with DALK. The first part of the surgery was uneventful with a successful creation of the big bubble. During the placement of the donor, following endothelial removal, an attempt to remove an air bubble at the interface caused a rupture of Descemet membrane (DM) with a collapse of the anterior chamber. The surgery continued with a the suture of the donor cornea and an air injection in the AC to aid the adhesion of DM. Examinations of the anterior chamber with OCT Visante (Zeiss), to evaluate the position of DM, were performed in follow up.
Results:
Post operative OCT Visante showed corneal edema and detachment of DM which appeared interrupted and enrolled, for this reason a second surgery was planned. Unrolling of DM was accomplished through the use of surgical irrigation cannula. An air bubble was then injected with the aim to re-attach DM. The following day, a new OCT examination still showed cornea edema and DM appeared flat without visible interruption however separated from the donor graft. Subsequently an iridectomy and an air bubble over filling was performed. Postoperative OCT examination showed a complete adhesion of DM and reduction of cornea edema that kept reducing in the upcoming exams.
Conclusions:
Based on our experience we suggest, in case of a DM tear happened after the removal of donor endothelium, to perform a surgical flattening of an enrolled Descemet followed by AC filling with air and, if necessary, iridectomy with AC air over filling to avoid more invasive procedure such as penetrating keratoplasty.
Financial Disclosure:
NONE
