Deep Anterior Lamellar Keratoplasty with IntraStromal Injection of Air

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Deep Anterior Lamellar Keratoplasty with
Intra-Stromal Injection of Air

• Hassan Hashemi MD1,2
• Mohammad Amin Seyedian MD1,3
• Shakiba Ebadollahi MD1

• Noor Vision Correction Centre, Tehran, Iran
• Farabi Eye Hospital, Tehran University, Tehran,
  Iran
• Moorfields Eye Hospital, London, United Kingdom

Financial Interest Disclosure None
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Purpose

• PK is technically easier and has a good visual
  prognosis, but the long-term prognosis may not be
  optimal. Immunologic rejection occurs in 20 to
  30 of patients following PK. In addition
  continuous loss of corneal endothelium is a major
  concern after PK
• Deep anterior lamellar keratoplasty (DALK)
  techniques have improved recently so that a
  full-thickness corneal stroma and epithelial
  button may be placed onto a host bed containing
  no stromal tissue on top of Descemets membrane

To elucidate the efficacy and safety of DALK
using Big-Bubble technique described By Anwar
and Teichmann, in a case series
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Patients

• Number of patients 19
• Number of eyes 19
• Sex
• Male 14
• Female 5
• Age (years)
• Range 23 - 42
• Mean 30.6

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Indications for Keratoplasty

• Keratoconus 12
• Post-LASIK Corneal Ectasia 3
• Corneal Macular Dystrophy 2
• Corneal Stromal Scar 2
• All patients were contact lens intolerant
• Cases with previous ruptures in Descemets
  membrane were excluded

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Surgical Technique Trephination
Partial Trephination to a depth of about 300 µ
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Injection of Air
Courtesy of Dr Mohammed Anwar
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Removal of the Stroma
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Preparing the Donor and Completing the Surgery
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Intraoperative Complications

• In 5 cases (26.31) the operation had to be
  changed to penetrating keratoplasty (PK). Most of
  these eyes were among the first cases
• From 14 successful cases, 1 had uneventful
  intraoperative Descemets membrane rupture. This
  case was not complicated by second chamber
  formation

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Results

• Follow-Up time (month)
• -Mean 13
• -Range 9 24
• BSCVA
• -Median 20/30
• -Range 20/50 20/20
• Mean Spherical
• Equivalent (D) -1.85

• Mean Topographic
• Astigmatism (D) 4.12
• Mean Endothelial Cell Loss
• -6 Month After the
• surgery 7.75
• -Month 6 to the Last
• follow-up 1.05

There was not any rejection episode in the
operated eyes
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Conclusion

• The Big-Bubble is a technically difficult
  procedure especially early in the learning curve
• DALK allows the risk of endothelial rejection to
  be avoided and reduces the risk of late
  endothelial failure
• More donor corneas can be used since it does not
  require a healthy donor endothelium, an important
  issue in countries with lack of cornea donors
• The final BSCVA and astigmatism results with this
  surgery are comparable with those after PK

PK no longer a first choice for the surgical
treatment of stromal diseases of cornea
with healthy endothelium
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Acknowledgment

• Mohammed Anwar FRCS
• Magrabi Eye Ear Hospital, Jeddah, Saudi Arabia