To report the effect of DLKP, we introduce 2 cases of patients with impending corneal perforation'

1
Effect of Deep Lamellar Keratoplasty on
Impending Corneal Perforation Jin Hyung Kim,
Young Dong Cha, Do Hyung Lee Department of
Ophthalmology, Ilsan Paik Hopital, Inje University
Inje University Ilsan Paik Hospital
Introduction
To report the effect of DLKP, we introduce 2
cases of patients with impending corneal
perforation.
Sample 1 A 41 year-old women with unilateral
acid burns of the left eye was referred to our
eye clinic. Her vision was limited to hand motion
and corneal epithelium was totally damaged.
Biomicroscopic examination of the left eye
revealed almost all limbal tissue was damaged and
the cornea impended to perforate. Despite 4 times
of AMT and auto limbal transplantations were
performed, central persistent epithelial defect
and progressive stromal melting were
developed(Fig. 1). After allo limbal
transplantation, the patient gained the stable
corneal surface. As a treatment of corneal
opacity, DLKP was performed and a double anterior
chamber was formed on postop. 1st day(Fig. 2).
Air injection was done on postop. 2nd and 4th
day(Fig. 3, 4) and 6 months of follow up, the
recur was not detected.
Case
1st Air injection
2nd Air injection
DLKP
Fig. 1 after limbal transplantation
Fig. 4 POD5
Fig. 2 POD1
Fig. 3 POD2
Sample 2 A 59 year-old women with corneal ulcer
(4.0 4.5mm) was referred to our department. Her
cornea was impending perforation with
hypopyon(Fig. 4). After 13th day AMT was done,
DLKP was performed. Postop 1st day, double
anterior chamber (Fig. 6) was formed and air
injection was done on postop. 3rd and 7th
day(Fig. 7,8). 4 months of follow up, the recur
was not detected.
1st Air injection
2nd Air injection
DLKP
A
     
Fig.6 POD1
Fig. 7 POD3
Fig. 8 POD8
Fig. 5 initial visiting
Ultimate purpose of the keratoplasty is to keep
transparency of the cornea. It is reported that
decreasing of endothelial cells, prime cause of
the rejection after surgery was less in DLKP
than in PKP. DLKP is a upgraded technique of the
PKP, to keep recipiants endothelial cells with
removal of stroma. A strong points include fewer
endothelial rejection and closed eye surgery. So
almost cases except bullous keratopathy with
endothelial abnormality were indicated of DLKP.
Most common complication of DLKP is the double
anterior chamber, incomplete fusion between
donors stroma and recipiants endothelium. It
can be disappeared by itself, but almost needs
injection of air or viscoelastics, corneal
suture. Air injection of the double anterior
chamber is easily performed in out-patient
department and obtain good results like above
samples.
Discussion