Rescue Technique to Solve Postoperative Refractory Double Anterior Chamber in Deep Anterior Lamellar Keratoplasty

Cornea ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Takahiko Hayashi ◽  
Sebastian Siebelmann
Keyword(s):  
Anterior Chamber ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Anterior Lamellar Keratoplasty ◽  
Rescue Technique

scholarly journals Intraocular Pressure Changes Following Different Keratoplasty Techniques and Association with Cornea Parameters and anterior Chamber Depth

2021 ◽  
Author(s):  
Gülşah Gümüş ◽  
cigdem altan ◽  
yusuf yildirim ◽  
nilay kandemir besek ◽  
selim genç ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Corneal Thickness ◽  
Anterior Chamber Depth ◽  
Early Postoperative Period ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Anterior Lamellar Keratoplasty ◽  
The Difference ◽  
Pressure Changes

Abstract Purpose To evaluate early intraocular pressure (IOP) changes following different keratoplasty techniques and to investigate the relationship between corneal thickness (CT), keratometry values, anterior chamber depth (ACD) and IOP changes. Methods We included patients who underwent penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK). ACD, CT, and keratometry measurements were repeated postoperatively at hour 24, week 1, and month 1. IOP measurements were repeated at postoperative hours 6 and 24, week 1, and month 1 by Tono-Pen XL. Results Twenty-two patients underwent PK, 12 patients underwent DALK, and 19 patients underwent DMEK. The difference between the IOP preoperatively and 6 hours postoperatively and between the IOP preoperatively and 24 hours postoperatively were statistically significant in the three types of surgery (p < 0.05 for each). The difference between preoperative and postoperative week 1 IOP was statistically significant only in the PK group (p = 0.023). When the IOP was compared between the three types of surgeries, the IOP at postoperative week 1 in the PK group was significantly higher than the DALK and DMEK groups (p = 0.021). There was no correlation between ACD, corneal thickness, K values, and IOP in any group. Conclusion IOP may increase in all types of keratoplasty during the first hours after surgery, but PK has a risk of high IOP longer in the early postoperative period. PK patients should be followed more carefully during postoperative week 1 to check for an increase in IOP.

Stromal peeling for deep anterior lamellar keratoplasty in post-penetrating keratoplasty eyes

2020 ◽  
pp. bjophthalmol-2020-316653
Author(s):  
Cristina Bovone ◽  
Yoav Nahum ◽  
Vincenzo Scorcia ◽  
Giuseppe Giannaccare ◽  
Rossella Spena ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Penetrating Keratoplasty ◽  
Large Diameter ◽  
Cell Loss ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Endothelial Cell Loss ◽  
Corrected Visual Acuity ◽  
Anterior Lamellar Keratoplasty ◽  
Stromal Component

Background/aimsTo evaluate the clinical outcomes of deep anterior lamellar keratoplasty performed by stromal peeling in eyes that have previously undergone penetrating keratoplasty (PK) for keratoconus.MethodsStandardised stromal exchange included (1) 9 mm trephination of the recipient bed outside the old PK wound, (2) creation of a partial anterior corneal flap through lamellar dissection across the PK wound, (3) opening the stromal component of the old PK wound using blunt-tipped Vannas scissors until a plane of separation is reached, (4) severing the attachment of the PK surgical scar from the recipient host, (5) peeling the stroma of the PK graft from the underlying tissue and (6) suturing the donor anterior corneal lamella prepared by microkeratome dissection (450 µm depth, 9 mm diameter). Main outcome measures were success rate, best spectacle-corrected visual acuity (BSCVA) and endothelial cell loss (ECL).ResultsOf 21 post-PK eyes, stromal exchange succeeded in all but three cases, which were converted to a two-piece mushroom PK. After complete suture removal, mean BSCVA significantly improved from 0.95±0.39 logMAR preoperatively to 0.23±0.17 logMAR (p<0.001). Mean ECL was 5.4±23.2%. Double anterior chamber formation occurred in eight cases (44%), which all resolved after a single re-bubbling.ConclusionIn post-PK eyes, stromal exchange can be performed by means of simple peeling without deep anterior lamellar dissection of the previous PK graft. Large-diameter (9 mm) repeat keratoplasty through stromal peeling yields excellent visual outcomes and minimal ECL. Double anterior chamber formation may complicate the postoperative course, but prompt intervention allows successful management.

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.

Manual deep anterior lamellar keratoplasty after partial unintentional full-thickness trephination

2020 ◽  
pp. 112067212093210
Author(s):  
Enrica Sarnicola ◽  
Caterina Sarnicola ◽  
Albert Y Cheung ◽  
Edoardo Panico ◽  
Claudio Panico ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Full Thickness ◽  
Air Bubble ◽  
Corrected Visual Acuity ◽  
Anterior Lamellar Keratoplasty ◽  
Bed Thickness ◽  
Post Infectious

Purpose: The aim of this study was to describe a surgical technique to perform deep anterior lamellar keratoplasty (DALK) despite inadvertent full thickness trephination in one quadrant. Methods: Case report of a 19-year-old boy who underwent DALK for visually significant post-infectious stromal scar in his left eye. An unintentional full thickness trephination occurred in the upper-nasal quadrant at the beginning of the surgery. After suturing the perforated area, manual DALK was performed, and an air bubble was left in the anterior chamber. Evaluated outcomes included best spectacle corrected visual acuity (BSCVA), residual recipient bed thickness, endothelial cell count (ECC), graft clarity, rejection, and presence/absence of double anterior chamber. Results: The surgery was completed without any further complications. No double anterior chamber or Urrets–Zavalia syndrome was observed on the first postoperative day. Mean residual recipient bed thickness was 72 μm and regular. ECC was 2446 cell/mm2. BSCVA at 18 months of follow-up was 0.9. There were no episodes of rejection, and the graft remained clear at the last follow-up (4 years). Conclusion: Inadvertent partial full thickness trephination of the recipient cornea is a largely preventable but possible complication during DALK. Penetrating keratoplasty conversion can be avoided by performing a manual dissection DALK.

Microbubble Incision as a New Rescue Technique for Big-Bubble Deep Anterior Lamellar Keratoplasty With Failed Bubble Formation

Cornea ◽  
2013 ◽  
Vol 32 (2) ◽  
pp. 125-129 ◽  
Author(s):  
Stephan Riss ◽  
Ludwig M. Heindl ◽  
Björn O. Bachmann ◽  
Friedrich E. Kruse ◽  
Claus Cursiefen
Keyword(s):  
Bubble Formation ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Anterior Lamellar Keratoplasty ◽  
Rescue Technique ◽  
Big Bubble

Anterior Chamber Epithelial Cyst After Uneventful Deep Anterior Lamellar Keratoplasty

Cornea ◽  
2016 ◽  
Vol 35 (10) ◽  
pp. 1372-1374 ◽  
Author(s):  
José F. Costa ◽  
Marco Rego ◽  
Andreia Rosa ◽  
Esmeralda Costa ◽  
Pedro Fonseca ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Epithelial Cyst ◽  
Anterior Lamellar Keratoplasty

A singular case of iatrogenic gas-filled double anterior chamber after DALK

2020 ◽  
pp. 112067212097361
Author(s):  
Fabrizio Gaetano Saverio Franco ◽  
Lidia Vicchio ◽  
Marco Branchetti ◽  
Roberto Vignapiano ◽  
Fabrizio Giansanti
Keyword(s):  
Anterior Chamber ◽  
Corneal Stroma ◽  
Healthy Woman ◽  
Spontaneous Resolution ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Descemet Membrane ◽  
Anterior Lamellar Keratoplasty ◽  
Wait And See ◽  
Descemet Membrane Detachment

Aim: To present a case of double anterior chamber after DALK and its surgical management. Case description: A 67-year-old healthy woman underwent deep anterior lamellar keratoplasty (DALK) in her right eye for keratoconus with the big-bubble technique. About 7 days after surgery a partial detachment of the Descemet membrane from the posterior corneal stroma was revealed using AS-OCT (double anterior chamber appearance). In spite of two injections in the anterior chamber of air and gas on the 7th and 9th post-operative days respectively, the double anterior chamber still persisted. Furthermore, both air and gas passed through the little perforation of the host Descemet membrane-endothelium complex and enlarged the space between the stroma and Descemet membrane. About 10 weeks after DALK, a spontaneous resolution of the double anterior chamber was observed. Conclusion: This case suggests that an injection of air or gas into the anterior chamber, to deal with a Descemet membrane detachment following perforation during DALK procedure, can enlarge the double anterior chamber by increasing the space between stroma and Descemet membrane. These cases can be managed with a “wait and see” strategy for a spontaneous resolution to Descemet membrane detachment.

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