Deep trephination to standardize pneumatic dissection and speed up the learning curve of deep anterior lamellar keratoplasty

Session Details

Session Title: Cornea - Surgical III

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

Paper Time: 16:09

Venue: Room 16

First Author: : M.Busin ITALY

Co Author(s): :    V. Scorcia   P. Leon   M. Mimouni   Y. Nahum           

Abstract Details

Purpose:

To evaluate the use of a deep trephination to standardize deep anterior lamellar keratoplasty (DALK), thus yielding a high success rate and speeding up the learning curve of pneumatic dissection.

Setting:

Retrospective cohort study of eyes operated at a private hospital by a single surgeon (MB). 1illa Igea Hospital, Forli, Italy.

Methods:

Success rates and learning curves were analyzed in non-scarred keratoconic eyes undergoing DALK with 2 different techniques, differing mainly in the depth of trephination (technique 1=300 µm; technique 2=500-550 µm) and in the subsequent insertion of blunt probe and dedicated cannula at the base of the trephination (technique 1=downwards trying to reach a plane as close as possible to Descemet membrane; technique 2=tangentially trying to maintain the plane reached by the trephination).

Results:

The rate of big bubble formation of technique 1 (26/51 eyes=50.9%) was significantly lower (p<0.0001) than that of technique 2 (48/53 eyes=90.6%). A significant correlation between number of cases performed and success rate was found only for technique 1. The only microperforation occurring during deep trephination was managed by conversion to mushroom keratoplasty.

Conclusions:

Deep trephination up to 500-550 µm is instrumental in obtaining a significant flattening of the learning curve of pneumatic dissection, while achieving a constant success rate above 80%.

Financial Interest:

NONE