Pre-Descemetic DALK as primary management for acute hydrops: is it time for a shift in opinion and are there advantages?

Session Details

Session Title: Presented Poster Session: Refractive Surgery New Techniques/Instrumentation/Devices II

Venue: Poster Village: Pod 2

First Author: : S.Jacob INDIA

Co Author(s): :                           

Abstract Details

Purpose:

To report pre-Descemetic deep anterior lamellar keratoplasty (pdDALK) as primary treatment for acute corneal hydrops (CH).

Setting:

Dr. Agarwal's Eye Hospital, Chennai, India

Methods:

This prospective interventional case series included 9 eyes with acute CH who underwent pdDALK as primary treatment. Technique modifications included bevel up needle, creating tissue emphysema as guide for dissection, using small aliquots of air directed away from break, manual deeper dissection using blunt dissector, centripetal dissection leaving area of Descemet’s membrane (DM) break for last, retention of minimal stroma above DM tear and tamponade of DM tear with air in anterior chamber. In eyes with extensive edema or thin residual stroma, an inked trephine mark was manually deepened with sharp crescent blade, followed by other modifications.

Results:

All patients underwent uneventful surgery without enlargement of DM tear. Average follow-up was 18 ± 13.02 months. All showed clear, non-edematous graft with area of DM defect and overlying cornea continuing to show clarity at last post-operative follow-up. ASOCT showed 90.8 ± 32 microns residual pre-Descemetic host stroma on either side of the defect. CDVA improved from 0.002 ±0.005 pre-operatively to 0.35 ± 0.1 by an average of 2.3 ± 0.86 weeks and to 0.52 ± 0.13 at final post-operative follow-up.

Conclusions:

Primary pdDALK was possible as single stage definitive treatment in our case series. Simultaneous correction of pathology by closure of DM break, anatomical correction of ectasia and thinning, optical correction by regaining corneal structure and transparency as well as retention of host DM and endothelium are advantages. ¬¬Advanced DALK surgeons may employ this technique.

Financial Disclosure:

None