Abstract
Background: To describe a simple technique for Descemet membrane exposure during deep anterior lamellar keratoplasty (DALK).Methods: As a prospective interventional case series, consecutive patients who underwent DALK were enrolled. The technique involved the separation of the Descemet membrane by injecting air and ophthalmic viscosurgical devices from the point where transconjunctival single-plane sclerocorneal incision with the slit knife is terminated prior to perforation using a mirror image. Descemet membrane exposure success rates and the incidence of intra- and postoperative complications were analyzed. Outcomes of successful DALK procedures, which were not converted to penetrating keratoplasty, were analyzed by evaluating best corrected visual acuity (BCVA; converted to logarithm of the minimum angle of resolution [logMAR]) and graft survival.Results: We included 11 eyes from 11 patients (seven males and four females; 53.6 ± 16.1 years; mean follow-up duration, 26.1 weeks [6–51 weeks]). Ten surgeries were successful in Descemet membrane exposure without rupture, eight were successful in big-bubble formation, and two were finally successful in Descemet membrane exposure after a failed big-bubble. The DALK procedure for only one eye was converted to a penetrating keratoplasty owing to a tear in the Descemet membrane. BCVA improved from 0.83 ± 0.38 logMAR preoperatively to 0.24 ± 0.12 logMAR postoperatively (n=10, p < 0.001). There was no primary graft failure.Conclusion: This simple technique of transconjunctival single-plane sclerocorneal incision could be very useful for exposing the Descemet membrane during DALK.
Descemetic and Predescemetic DALK in Keratoconus Patients: A Clinical and Confocal Perspective Study
