DALK for keratoconus: blunt cannula vs anwar technique

Session Details

Session Title: Cornea - Surgical III

Session Date/Time: Sunday 06/09/2015 | 14:15-16:15

Paper Time: 14:53

Venue: Room 16

First Author: : E.Sarnicola ITALY

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

Abstract Details

Purpose:

To evaluate outcomes and possible advantages of two different DALK techniques in patients with keratoconus: cannula big bubble DALK (cDALK) versus needle big bubble DALK (nDALK, Anwar technique).

Setting:

Misericordia Hospital

Methods:

Retrospective, non consecutive, comparative study of 507 eyes affected by keratoconus, which underwent DALK procedure between 2000 and 2012. The nDALK technique was used in 266 eyes, and the cDALK technique in 241 eyes. When big bubble failed, airviscobubble (AVB) was used as a rescue bubble technique. When AVB failed, layer by layer manual dissection was performed. Main outcomes analyzed were the frequency of descemetic DALK (dDALK) and predescemetic DALK (pdDALK), the rate of big bubble and AVB formation, the frequency of Descemet membrane (DM) ruptures during the procedure, and the PK conversion rate. Endothelial cell loss was also evaluated.

Results:

Of the nDALK group, dDALK was achieved in 207 cases (78%): big bubble occurred in 161 cases (61%), and AVB in 46 cases (17%). Of the cDALK group, dDALK was achieved in 226 cases (94%): big bubble occurred in 198 cases (82%), and AVB in 28 cases (12%). Of the nDALK group pdDALK occurred in 59 cases (22%), and in 15 cases (6%) of the cDALK group. Microperforation occurred in 12 cases (4,5%) of the nDALK group, and in 6 cases (2,5%) of the cDALK group (p<0.05). Macroperforation occurred in 5 cases (2%) of the nDALK group. Double chamber occurred in 7 cases (4 nDALK, 3 cDALK). No DM perforation occurred during air injection. No PK conversion was needed.

Conclusions:

The use of a smooth cannula during DALK procedure facilitates a higher percentage of dDALK (p <0.01) and make the maneuver more manageable compared to air injection with a needle. When big bubble fails, AVB seems to be a good rescue technique to achieve a dDALK

Financial Interest:

NONE