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First Author: A.Hashem SAUDI ARABIA
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To describe a surgical technique in the management of large Descemet membrane (DM) tears during deep anterior lamellar keratoplasty.
Magrabi Eye Hospital - Jeddah -Kingdom of Saudi Arabia
Two patients with advanced keratoconus underwent DALK, after failure to obtain big-bubble and during layer-by-layer stromal dissection a large DM tears (more than 1 mm in length) occurred, the perforations were too big to be temporarly sealed with external application of stromal patch and anterior chamber reformation with air was not possible due to the big size of the perforations. Suturing of stromal patch from the previously dissected tissue was successfully used to seal the tear and to complete stromal dissection.
At last follow up visit (6 months in case 1 and 1 year in case 2) both cases had clear corneal graft with clear interface and good optical results.Manifest refraction was -1.5 -3.0 x 140 with 20/25 BSCVA in case 1 and plano -3.0 x 30 with 20/20 BSCVA in case 2, endothelial cell count was 1862 cell/mm2 in case 1 and 2618 cell/mm2 in case 2
the use of stromal patch suturing in the management of large DM tear in DALK may be a useful technique.