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Successful pneumatic dissection through modified DALK technique in post-lamellar keratoplasty eyes

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First Author: G.Galante ITALY

Co Author(s):    C. Bovone   A. Yu   S. Socea   M. Busin           

Abstract Details

Purpose:

To evaluate the surgical and clinical outcomes of modified big bubble deep anterior lamellar keratoplasty (DALK) for post-lamellar keratoplasty eyes

Setting:

Tertiary referral center (Ospedali Privati Forlì, Villa Igea)

Methods:

From April 2013 to September 2017, 20 consecutive eyes with unsatisfactory vision following anterior lamellar keratoplasty (ALK) without Descemet baring, (superficial ALK n=9; excimer-laser assisted ALK n=6; epikeratophakia n=5) underwent large diameter (9mm) repeat lamellar keratoplasty utilizing pneumatic dissection. In all cases, surgery involved deep trephination, minimal centripetal advancement of the cannula (2-mm) pneumatic dissection and limited (6-mm) stromal clearance of the optical zone. Success rates of pneumatic dissection, complication rates, visual and refractive outcomes were reported.

Results:

Pneumatic dissection with type 1 bubble formation succeeded in 18 (90%) eyes. In the remaining 2 cases, the 6mm optical zone was cleared by manual dissection after failed bubble formation. Perforation occurred in one of the latter cases; no procedure was converted to penetrating keratoplasty. With a mean follow-up of 52±19 months, Snellen BSCVA ³20/20 and ³20/40 was achieved in 8 (40%) and 20 (100%) eyes respectively. After complete suture removal, refractive astigmatism was £ 4.5 D and <6D in 19 eyes (95%) and 20 eyes (100%) respectively. Stromal rejection was observed in 2 eyes (10%).

Conclusions:

Even in eyes with previous ALK, pneumatic dissection can be reproducibly achieved through a modified DALK technique with low risk of complications and excellent visual and refractive outcomes.

Financial Disclosure:

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