Successful Deep Anterior Lamellar Keratoplasty in  Pre-existing Descemet Membrane Perforation - A Case Series

Shreesha Kumar Kodavoor; Bijita Deb; Soundarya Balajee; Ramamurthy Dandapani

doi:doi:10.11648/j.ijovs.20200503.11

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Successful Deep Anterior Lamellar Keratoplasty in Pre-existing Descemet Membrane Perforation - A Case Series

Shreesha Kumar Kodavoor, Bijita Deb, Soundarya Balajee, Ramamurthy Dandapani

Published in International Journal of Ophthalmology & Visual Science (Volume 5, Issue 3)

Received: 16 June 2020 Accepted: 30 June 2020 Published: 13 July 2020

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Abstract

Aim: To analyse the outcome of Deep anterior lamellar keratoplasty (DALK) in cases of pre-existing DM (Descemet membrane) tear. Method: 14 eyes with pre-existing perforation (4 eyes with advanced keratoconus post collagen crosslinking and post Toric implantable collamer lens explantation and 10 eyes with post healed hydrops) who underwent DALK were included. Manual layer by layer dissection by a special technique was employed. Results: Minimum follow up-1 year. All patients had good post-operative results with mean UCVA preoperative and postoperative value of 1.35±0.25 LogMAR and 0.68 ± 0.19 LogMAR respectively with ‘p’ value of 0.00001 which was significant. Mean astigmatism preoperative and postoperative was found to be 4.82±1.76D and 2.66±0.7D and ‘p’ value was significant (p=0.00042). Mean endothelial count preoperative and postoperative was 2479.18±239.42cells/cm² and 2238.45±218.49cell/cm² with percentage reduction of 9.6% at 1 year. Two eyes among them had postoperative double anterior chamber and two eyes had wrinkling of DM due to the advanced nature of KC. Conclusion: DALK can be successful in patients with pre-existing DM perforation if careful precautions are taken. Also layer by layer technique with a centripetal dissection is preferred in such cases to prevent intraoperative scar extension.

Published in	International Journal of Ophthalmology & Visual Science (Volume 5, Issue 3)
DOI	10.11648/j.ijovs.20200503.11
Page(s)	70-74
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Pre-existing Descemet’s Membrane Perforation, Post Hydrops DALK, DALK in DM Perforation

References

[1]	Das S, Dua N, Ramamurthy B. Deep lamellar keratoplasty in keratoconus with healed hydrops. Cornea. 2007 Oct; 26 (9): 1156–7.
[2]	Reinhart WJ, Musch DC, Jacobs DS, Lee WB, Kaufman SC, Shtein RM. Deep anterior lamellar keratoplasty as an alternative to penetrating keratoplasty a report by the american academy of ophthalmology. Ophthalmology. 2011 Jan; 118 (1): 209–18.
[3]	Javadi MA, Feizi S, Yazdani S, Mirbabaee F. Deep anterior lamellar keratoplasty versus penetrating keratoplasty for keratoconus: a clinical trial. Cornea. 2010 Apr; 29 (4): 365–71.
[4]	Romano V, Iovieno A, Parente G, Soldani AM, Fontana L. Long-term clinical outcomes of deep anterior lamellar keratoplasty in patients with keratoconus. Am J Ophthalmol. 2015 Mar; 159 (3): 505–11.
[5]	Nanavaty MA, Daya SM. Outcomes of deep anterior lamellar keratoplasty in keratoconic eyes with previous hydrops. Br J Ophthalmol. 2012 Oct; 96 (10): 1304–9.
[6]	Ramamurthi S, Ramaesh K. Surgical management of healed hydrops: a novel modification of deep anterior lamellar keratoplasty. Cornea. 2011 Feb; 30 (2): 180–3.
[7]	Chew ACY, Mehta JS, Tan DTH. Deep lamellar keratoplasty after resolution of hydrops in keratoconus. Cornea. 2011 Apr; 30 (4): 454–9.
[8]	Anwar HM, Anwar M. Predescemetic dissection for healed hydrops--judicious use of air and fluid. Cornea. 2011 Dec; 30 (12): 1502–9.
[9]	Kodavoor SK, Deb B, Ramamurthy D. Outcome of deep anterior lamellar keratoplasty patients with intraoperative Descemet’s membrane perforation: A retrospective cross-sectional study. Indian J Ophthalmol. 2018 Nov; 66 (11): 1574–9.
[10]	Jacob S, Narasimhan S, Agarwal A, Sambath J, Umamaheshwari G, Saijimol AI. Primary Modified Predescemetic Deep Anterior Lamellar Keratoplasty in Acute Corneal Hydrops. Cornea. 2018 Oct; 37 (10): 1328–33.

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APA Style

Shreesha Kumar Kodavoor, Bijita Deb, Soundarya Balajee, Ramamurthy Dandapani. (2020). Successful Deep Anterior Lamellar Keratoplasty in Pre-existing Descemet Membrane Perforation - A Case Series. International Journal of Ophthalmology & Visual Science, 5(3), 70-74. https://doi.org/10.11648/j.ijovs.20200503.11

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ACS Style

Shreesha Kumar Kodavoor; Bijita Deb; Soundarya Balajee; Ramamurthy Dandapani. Successful Deep Anterior Lamellar Keratoplasty in Pre-existing Descemet Membrane Perforation - A Case Series. Int. J. Ophthalmol. Vis. Sci. 2020, 5(3), 70-74. doi: 10.11648/j.ijovs.20200503.11

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AMA Style

Shreesha Kumar Kodavoor, Bijita Deb, Soundarya Balajee, Ramamurthy Dandapani. Successful Deep Anterior Lamellar Keratoplasty in Pre-existing Descemet Membrane Perforation - A Case Series. Int J Ophthalmol Vis Sci. 2020;5(3):70-74. doi: 10.11648/j.ijovs.20200503.11

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@article{10.11648/j.ijovs.20200503.11,
  author = {Shreesha Kumar Kodavoor and Bijita Deb and Soundarya Balajee and Ramamurthy Dandapani},
  title = {Successful Deep Anterior Lamellar Keratoplasty in  Pre-existing Descemet Membrane Perforation - A Case Series},
  journal = {International Journal of Ophthalmology & Visual Science},
  volume = {5},
  number = {3},
  pages = {70-74},
  doi = {10.11648/j.ijovs.20200503.11},
  url = {https://doi.org/10.11648/j.ijovs.20200503.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20200503.11},
  abstract = {Aim: To analyse the outcome of Deep anterior lamellar keratoplasty (DALK) in cases of pre-existing DM (Descemet membrane) tear. Method: 14 eyes with pre-existing perforation (4 eyes with advanced keratoconus post collagen crosslinking and post Toric implantable collamer lens explantation and 10 eyes with post healed hydrops) who underwent DALK were included. Manual layer by layer dissection by a special technique was employed. Results: Minimum follow up-1 year. All patients had good post-operative results with mean UCVA preoperative and postoperative value of 1.35±0.25 LogMAR and 0.68 ± 0.19 LogMAR respectively with ‘p’ value of 0.00001 which was significant. Mean astigmatism preoperative and postoperative was found to be 4.82±1.76D and 2.66±0.7D and ‘p’ value was significant (p=0.00042). Mean endothelial count preoperative and postoperative was 2479.18±239.42cells/cm2 and 2238.45±218.49cell/cm2 with percentage reduction of 9.6% at 1 year. Two eyes among them had postoperative double anterior chamber and two eyes had wrinkling of DM due to the advanced nature of KC. Conclusion: DALK can be successful in patients with pre-existing DM perforation if careful precautions are taken. Also layer by layer technique with a centripetal dissection is preferred in such cases to prevent intraoperative scar extension.},
 year = {2020}
}

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TY  - JOUR
T1  - Successful Deep Anterior Lamellar Keratoplasty in  Pre-existing Descemet Membrane Perforation - A Case Series
AU  - Shreesha Kumar Kodavoor
AU  - Bijita Deb
AU  - Soundarya Balajee
AU  - Ramamurthy Dandapani
Y1  - 2020/07/13
PY  - 2020
N1  - https://doi.org/10.11648/j.ijovs.20200503.11
DO  - 10.11648/j.ijovs.20200503.11
T2  - International Journal of Ophthalmology & Visual Science
JF  - International Journal of Ophthalmology & Visual Science
JO  - International Journal of Ophthalmology & Visual Science
SP  - 70
EP  - 74
PB  - Science Publishing Group
SN  - 2637-3858
UR  - https://doi.org/10.11648/j.ijovs.20200503.11
AB  - Aim: To analyse the outcome of Deep anterior lamellar keratoplasty (DALK) in cases of pre-existing DM (Descemet membrane) tear. Method: 14 eyes with pre-existing perforation (4 eyes with advanced keratoconus post collagen crosslinking and post Toric implantable collamer lens explantation and 10 eyes with post healed hydrops) who underwent DALK were included. Manual layer by layer dissection by a special technique was employed. Results: Minimum follow up-1 year. All patients had good post-operative results with mean UCVA preoperative and postoperative value of 1.35±0.25 LogMAR and 0.68 ± 0.19 LogMAR respectively with ‘p’ value of 0.00001 which was significant. Mean astigmatism preoperative and postoperative was found to be 4.82±1.76D and 2.66±0.7D and ‘p’ value was significant (p=0.00042). Mean endothelial count preoperative and postoperative was 2479.18±239.42cells/cm2 and 2238.45±218.49cell/cm2 with percentage reduction of 9.6% at 1 year. Two eyes among them had postoperative double anterior chamber and two eyes had wrinkling of DM due to the advanced nature of KC. Conclusion: DALK can be successful in patients with pre-existing DM perforation if careful precautions are taken. Also layer by layer technique with a centripetal dissection is preferred in such cases to prevent intraoperative scar extension.
VL  - 5
IS  - 3
ER  -

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Author Information

Shreesha Kumar Kodavoor

Cornea Cataract and Refractive Services, The Eye Foundation, Coimbatore, India
Bijita Deb

Cornea Cataract and Refractive Services, The Eye Foundation, Coimbatore, India
Soundarya Balajee

Cornea Cataract and Refractive Services, The Eye Foundation, Coimbatore, India
Ramamurthy Dandapani

Cataract and Refractive Services, The Eye Foundation, Coimbatore, India

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APA Style

Shreesha Kumar Kodavoor, Bijita Deb, Soundarya Balajee, Ramamurthy Dandapani. (2020). Successful Deep Anterior Lamellar Keratoplasty in Pre-existing Descemet Membrane Perforation - A Case Series. International Journal of Ophthalmology & Visual Science, 5(3), 70-74. https://doi.org/10.11648/j.ijovs.20200503.11

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ACS Style

Shreesha Kumar Kodavoor; Bijita Deb; Soundarya Balajee; Ramamurthy Dandapani. Successful Deep Anterior Lamellar Keratoplasty in Pre-existing Descemet Membrane Perforation - A Case Series. Int. J. Ophthalmol. Vis. Sci. 2020, 5(3), 70-74. doi: 10.11648/j.ijovs.20200503.11

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AMA Style

Shreesha Kumar Kodavoor, Bijita Deb, Soundarya Balajee, Ramamurthy Dandapani. Successful Deep Anterior Lamellar Keratoplasty in Pre-existing Descemet Membrane Perforation - A Case Series. Int J Ophthalmol Vis Sci. 2020;5(3):70-74. doi: 10.11648/j.ijovs.20200503.11

Copy | Download

@article{10.11648/j.ijovs.20200503.11,
  author = {Shreesha Kumar Kodavoor and Bijita Deb and Soundarya Balajee and Ramamurthy Dandapani},
  title = {Successful Deep Anterior Lamellar Keratoplasty in  Pre-existing Descemet Membrane Perforation - A Case Series},
  journal = {International Journal of Ophthalmology & Visual Science},
  volume = {5},
  number = {3},
  pages = {70-74},
  doi = {10.11648/j.ijovs.20200503.11},
  url = {https://doi.org/10.11648/j.ijovs.20200503.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20200503.11},
  abstract = {Aim: To analyse the outcome of Deep anterior lamellar keratoplasty (DALK) in cases of pre-existing DM (Descemet membrane) tear. Method: 14 eyes with pre-existing perforation (4 eyes with advanced keratoconus post collagen crosslinking and post Toric implantable collamer lens explantation and 10 eyes with post healed hydrops) who underwent DALK were included. Manual layer by layer dissection by a special technique was employed. Results: Minimum follow up-1 year. All patients had good post-operative results with mean UCVA preoperative and postoperative value of 1.35±0.25 LogMAR and 0.68 ± 0.19 LogMAR respectively with ‘p’ value of 0.00001 which was significant. Mean astigmatism preoperative and postoperative was found to be 4.82±1.76D and 2.66±0.7D and ‘p’ value was significant (p=0.00042). Mean endothelial count preoperative and postoperative was 2479.18±239.42cells/cm2 and 2238.45±218.49cell/cm2 with percentage reduction of 9.6% at 1 year. Two eyes among them had postoperative double anterior chamber and two eyes had wrinkling of DM due to the advanced nature of KC. Conclusion: DALK can be successful in patients with pre-existing DM perforation if careful precautions are taken. Also layer by layer technique with a centripetal dissection is preferred in such cases to prevent intraoperative scar extension.},
 year = {2020}
}

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TY  - JOUR
T1  - Successful Deep Anterior Lamellar Keratoplasty in  Pre-existing Descemet Membrane Perforation - A Case Series
AU  - Shreesha Kumar Kodavoor
AU  - Bijita Deb
AU  - Soundarya Balajee
AU  - Ramamurthy Dandapani
Y1  - 2020/07/13
PY  - 2020
N1  - https://doi.org/10.11648/j.ijovs.20200503.11
DO  - 10.11648/j.ijovs.20200503.11
T2  - International Journal of Ophthalmology & Visual Science
JF  - International Journal of Ophthalmology & Visual Science
JO  - International Journal of Ophthalmology & Visual Science
SP  - 70
EP  - 74
PB  - Science Publishing Group
SN  - 2637-3858
UR  - https://doi.org/10.11648/j.ijovs.20200503.11
AB  - Aim: To analyse the outcome of Deep anterior lamellar keratoplasty (DALK) in cases of pre-existing DM (Descemet membrane) tear. Method: 14 eyes with pre-existing perforation (4 eyes with advanced keratoconus post collagen crosslinking and post Toric implantable collamer lens explantation and 10 eyes with post healed hydrops) who underwent DALK were included. Manual layer by layer dissection by a special technique was employed. Results: Minimum follow up-1 year. All patients had good post-operative results with mean UCVA preoperative and postoperative value of 1.35±0.25 LogMAR and 0.68 ± 0.19 LogMAR respectively with ‘p’ value of 0.00001 which was significant. Mean astigmatism preoperative and postoperative was found to be 4.82±1.76D and 2.66±0.7D and ‘p’ value was significant (p=0.00042). Mean endothelial count preoperative and postoperative was 2479.18±239.42cells/cm2 and 2238.45±218.49cell/cm2 with percentage reduction of 9.6% at 1 year. Two eyes among them had postoperative double anterior chamber and two eyes had wrinkling of DM due to the advanced nature of KC. Conclusion: DALK can be successful in patients with pre-existing DM perforation if careful precautions are taken. Also layer by layer technique with a centripetal dissection is preferred in such cases to prevent intraoperative scar extension.
VL  - 5
IS  - 3
ER  -

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