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Large (9 mm) Deep Anterior Lamellar Keratoplasty with Clearance of a 6-mm Optical Zone Optimizes Outcomes of Keratoconus Surgery
- Source :
- Ophthalmology. 124:1072-1080
- Publication Year :
- 2017
- Publisher :
- Elsevier BV, 2017.
-
Abstract
- Purpose To evaluate the outcomes of a 9-mm deep anterior lamellar keratoplasty (DALK) with removal of the deep stroma limited to the central 6-mm optical zone. Design Prospective, noncomparative, interventional case series. Participants A total of 80 consecutive keratoconic eyes without deep stromal scarring, with at least 1 postoperative examination 1 month after complete suture removal. Intervention A standardized DALK was performed, including (1) deep trephination of the recipient bed 450 to 550 μm in depth and 9 mm in diameter; (2) pneumatic dissection; (3) debulking of approximately 80% of the anterior stroma; (4) removal of the deep stroma (bubble roof) from a central 6-mm optical zone; and (5) transplantation of a 9-mm anterior corneal lamella cut by microkeratome-assisted dissection (400-μm head) and sutured with a double running 10-0 nylon suture. Main Outcome Measures Success rate and type of pneumatic dissection obtained; best spectacle-corrected visual acuity (BSCVA), refractive astigmatism (RA), and topographic astigmatism (TA), central corneal thickness (CCT) and endothelial cell density 12 months postoperatively; and intraoperative and postoperative complications. Results Pneumatic dissection created a "big bubble" in 67 of 80 eyes (83.7%), all of them but 1 (1.5%) being of type 1 according to the classification by Dua et al. After complete suture removal, BSCVA averaged 0.09±0.72 logarithm of the minimum angle of resolution (logMAR) and was ≥20/20 in 28 eyes (35%), ≥20/25 in 54 eyes (67.5%), and ≥20/40 in 76 eyes (95%); RA averaged 3.10±1.30 diopters (D), with 73 eyes (91%) within 4.5 D and none above 6 D; regular TA was detected in 72 eyes (90%); mean CCT was 492±62.10 μm; postoperative endothelial cell density averaged 2026±397cells/mm 2 with a mean cell loss of 11.2%. Intraoperative complications included loss of suction (n = 1) and perforation (n = 4). No conversion to penetrating keratoplasty was necessary. After surgery, double anterior chamber was observed in 2 cases (2.5%), both managed successfully by air filling of the anterior chamber. Stromal rejection was observed in 6 eyes (7.5%) and was reversed with topical steroids in all cases. Conclusions In keratoconic eyes without deep stromal scars, the combination of a graft larger than conventional ones with limited removal of deep stroma can improve visual and refractive outcomes of DALK, while minimizing the rate of complications.
- Subjects :
- medicine.medical_specialty
Keratoconus
Visual acuity
genetic structures
Perforation (oil well)
Visual Acuity
Astigmatism
NO
Cornea
03 medical and health sciences
0302 clinical medicine
medicine
Cornea, Corneal Topography, Keratoconus, Keratoplasty, Refraction, Visual Acuity, Ophthalmology
Dioptre
medicine.diagnostic_test
business.industry
Corneal Topography
Corneal topography
medicine.disease
eye diseases
Surgery
Transplantation
Refraction
Ophthalmology
medicine.anatomical_structure
Keratoplasty
030221 ophthalmology & optometry
medicine.symptom
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 01616420
- Volume :
- 124
- Database :
- OpenAIRE
- Journal :
- Ophthalmology
- Accession number :
- edsair.doi.dedup.....5b9605e7975c55d041754a1a28ee41fe