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First Author: S.Eissa EGYPT
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To identify incidence of conversion from deep anterior lamellar keratoplasty (DALK) to penetrating keratoplasty (PKP) in keratoconus eyes, recognize the cause, and determine the step where conversion is most common.
Kasr alainy, Cairo University hospitals, Cairo, Egypt
Retrospective analysis of 26 eyes (17 patients) with keratoconus, scheduled for DALK surgery, by 1 surgeon, in the period from September 2010 to August 2012.Data analysis of the operative sheets of the scheduled patients was done, including number of cases converted to PKP, steps during which conversion was decided, failure or success of big bubble, and location of descemet membrane perforation.
Conversion was decided in 5 eyes (19.23%), 1 eye had large central perforation of descemet membrane under a dense central scar during big air bubble injection, in 1 eye, large slit like perforation occurred during superblade first stab(puncture)to deroof the air bubble and 3 eyes had failed big bubble and manual lamellar dissection was done,2 eyes of which had large inferior perforations by the tip of Barraquer spatula during dissection and the last eye had perforation during stromal tissue cutting with Moria scissors . Trial of stromal plug sealing of the break and intracameral air injection was tried in the last three eyes; but failure to complete with DALK was the final outcome.
Success of big bubble is the key to achieve a successful DALK. During manual stromal dissection , descemet membrane perforation with spatula or scissor is not uncommon . Financial disclosure: No financial interest to disclose.