Clinical Properties and Risk Factors for Descemet Membrane Folds After Deep Anterior Lamellar Keratoplasty in Patients With Keratoconus

Cornea ◽  
2019 ◽  
Vol 38 (10) ◽  
pp. 1222-1227
Author(s):  
Xia Li ◽  
Yujin Zhao ◽  
Huiyu Chen ◽  
Yue Li ◽  
Jiaxu Hong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Descemet Membrane ◽  
Anterior Lamellar Keratoplasty

Corneal neovascularisation following deep anterior lamellar keratoplasty for corneal ectasia: incidence, timing and risk factors

2021 ◽  
pp. bjophthalmol-2021-319339
Author(s):  
Marco Pellegrini ◽  
Vincenzo Scorcia ◽  
Giuseppe Giannaccare ◽  
Andrea Lucisano ◽  
Sabrina Vaccaro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Age ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Topical Steroids ◽  
Ocular Allergy ◽  
Early Discontinuation ◽  
Corneal Ectasia ◽  
Increased Risk ◽  
Anterior Lamellar Keratoplasty

BackgroundThe purpose of this study was to evaluate the incidence, timing and risk factors of corneal neovascularisation (NV) after deep anterior lamellar keratoplasty (DALK) for corneal ectasia.MethodsThis study included 616 eyes who underwent DALK between 2012 and 2020 in two tertiary referral centres. In one centre topical corticosteroids were discontinued after complete suture removal 1 year after surgery, whereas in the other they were discontinued 3–4 months after surgery. The presence and severity of corneal NV was ascertained based on slit lamp photographs. Potential risk factors for corneal NV were evaluated using the Cox proportional hazards model.ResultsThe cumulative incidence of corneal NV was 8.7% at 1 year after surgery and 13.2% at 5 years. Mean time interval from surgery to development of corneal NV was 12.8±16.2 months, with 68.9% of cases occurring before complete suture removal. Early discontinuation of topical steroids, older age and ocular allergy were associated with an increased risk of developing corneal NV (respectively, HR=2.625, HR=1.019, HR=3.726, all p<0.05).ConclusionsThe risk of corneal NV is higher in the first year following DALK. Early discontinuation of topical steroids, ocular allergy and older age are significant predictors of corneal NV.

scholarly journals ‘Double Bubble’ Technique for Successful Reattachment of Total Descemet Membrane Detachment after Deep Anterior Lamellar Keratoplasty

2018 ◽  
Vol 10 (2) ◽  
pp. 180-183 ◽  
Author(s):  
Jeewan S. Titiyal ◽  
Manpreet Kaur ◽  
Sana Tinwala ◽  
Ruchita Falera
Keyword(s):  
Anterior Chamber ◽  
Air Injection ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Air Bubbles ◽  
Double Bubble ◽  
Air Bubble ◽  
Descemet Membrane ◽  
Anterior Lamellar Keratoplasty ◽  
Descemet Membrane Detachment

Background: A double anterior chamber may be observed after deep anterior lamellar keratoplasty (DALK) and the management may be difficult especially in cases with a total descemet membrane detachment (DMD). Case Observations: We describe a novel “reverse double bubble” surgical technique for safe and effective reattachment of  total DMD following DALK. Total DMD with air bubble in the interface was noted on the first postoperative day following DALK for healed keratitis. Intracameral air was injected via a 30-gauge needle inserted through a partial thickness MVR entry made at the posterior limbus, without disturbing the interface air-bubble. During this maneuver, the interface bubble did not change in size and moved towards the centre. The two distinct air bubbles, one in interface and other in anterior chamber indicated that air injection was in the anterior chamber, as per the reverse double bubble technique. The interface air bubble was removed by gently milking with an iris repositor towards the end of surgery. Thus, successful reattachment of DM was achieved despite difficult assessment of the plane of injection with the DM lying fl at on the surface of the iris. Conclusion: The reverse double bubble technique aids in the safe and successful reattachment of total DMD following intraocular surgeries.

scholarly journals Late Detachment after DALK in a Patient with Descemet Membrane Microperforation

2017 ◽  
Vol 1 (1) ◽  
pp. oapoc.0000010
Author(s):  
Marilia Lordello Passos ◽  
Vinicius Coral Ghanem ◽  
André Luís Piccinini ◽  
Ramon Coral Ghanem
Keyword(s):  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Descemet Membrane ◽  
Anterior Lamellar Keratoplasty ◽  
History Of

We report a case of late detachment in a patient with Descemet membrane (DM) microperforation following a deep anterior lamellar keratoplasty (DALK). Late detachment of the DM in this case occurred 5 months after DALK because of the flattening pressure during the retinal exam with scleral depression. In patients with a history of microperforation during DALK, we suggest that the retinologist and patient avoid rubbing or applying pressure over the eye to minimize the risk of late detachment of the DM.

scholarly journals Risk factors influencing survival of acellular porcine corneal stroma in infectious keratitis: a prospective clinical study

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Saiqun Li ◽  
Meng Li ◽  
Li Gu ◽  
Lulu Peng ◽  
Yuqing Deng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
Graft Survival ◽  
Graft Failure ◽  
Corneal Stroma ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Infectious Keratitis ◽  
Anterior Lamellar Keratoplasty

Abstract Background A worldwide lack of donor corneas demands the bioengineered corneas be developed as an alternative. The primary objective of the current study was to evaluate the efficacy of acellular porcine corneal stroma (APCS) transplantation in various types of infectious keratitis and identify risk factors that may increase APCS graft failure. Methods In this prospective interventional study, 39 patients with progressive infectious keratitis underwent therapeutic lamellar keratoplasty using APCS and were followed up for 12 months. Data collected for analysis included preoperative characteristics, visual acuity, graft survival and complications. Graft survival was evaluated by the Kaplan–Meier method and compared with the log-rank test. Results The percentage of eyes that had a visual acuity of 20/40 or better increased from 10.3% preoperatively to 51.2% at 12 months postoperatively. Twelve patients (30.8%) experienced graft failure within the follow-up period. The primary reasons given for graft failure was noninfectious graft melting (n = 5), and the other causes included recurrence of primary infection (n = 4) and extensive graft neovascularization (n = 3). No graft rejection was observed during the follow-up period. A higher relative risk (RR) of graft failure was associated with herpetic keratitis (RR = 8.0, P = 0.046) and graft size larger than 8 mm (RR = 6.5, P < 0.001). Conclusions APCS transplantation is an alternative treatment option for eyes with medically unresponsive infectious keratitis. Despite the efficacy of therapeutic lamellar keratoplasty with APCS, to achieve a good prognosis, restriction of surgical indications, careful selection of patients and postoperative management must be emphasized. Trial registration Prospective Study of Deep Anterior Lamellar Keratoplasty Using Acellular Porcine Cornea, NCT03105466. Registered 31 August 2016, ClinicalTrails.gov

scholarly journals Descemetic and Predescemetic DALK in Keratoconus Patients: A Clinical and Confocal Perspective Study

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Domenico Schiano-Lomoriello ◽  
Rossella Annamaria Colabelli-Gisoldi ◽  
Mario Nubile ◽  
Francesco Oddone ◽  
Giorgio Ducoli ◽  
...  
Keyword(s):  
Confocal Microscopy ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Layer By Layer ◽  
In Vivo Confocal Microscopy ◽  
Descemet Membrane ◽  
Anterior Lamellar Keratoplasty ◽  
A Minor ◽  
Big Bubble

Purpose. To evaluate the clinical outcomes and in vivo confocal microscopy (IVCM) features of keratoconus patients who underwent deep anterior lamellar keratoplasty (DALK).Methods. DALK was performed using the big bubble technique in all the patients. If the bubble was not successful to bare the descemet membrane, a manual dissection layer-by layer was performed to expose a deep stromal plane close to the DM. The patients were divided in two groups depending on the intraoperative baring of the descemet membrane: predescemetic DALK (PD-DALK) and descemetic DALK (D-DALK) group.Results. One month after surgery the D-DALK patients show an increase of mean BCVA. In the PD-DALK group mean BCVA did not show significant improvement as compared to preoperative values. At 6 months after surgery mean BCVA was found to be similar in both groups. At 1 month IVCM the peak of reflectivity of the interface was lower in D-DALK group compared to PD-DALK. At 6 months the values of reflectivity were comparable.Conclusions. At 1 month D-DALK seems to lead to a minor interface reflectivity and to a better BCVA; these differences disappear after 6 months and the values of interface reflectivity and BCVA are comparable between D-DALK and PD-DALK.

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