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Surgical outcome of deep anterior lamellar keratoplasty with air-assisted manual dissection for corneas with previous inflammation or fibrosis

Poster Details

First Author: Y.Ho TAIWAN

Co Author(s):    D. Ma                    

Abstract Details


To report our experience in air-assisted manual dissection deep anterior lamellar keratoplasty (DALK) for the treatment of corneal scar with previous inflammation and fibrosis.


We retrospectively reviewed the medical records of patients who had undergone DALK between 2008 and 2014 in the Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.


We retrospectively reviewed the medical history of 21 patients (M : F = 13 : 8 mean age 41.9 years old) with corneal pathology from previous infection and inflammation. Trephination diameter ranged from 7.0 - 8.0 mm, and the graft was oversized by 0.25 to 0.50 mm. Debulking technique was performed to expose Descement�â�€�™s membrane after filling stroma with air. Starting from post-operative 3 months, selective suture removal was performed to reduce corneal astigmatism.


The mean follow-up period was 59.9 �Â�± 19.8 (20-96) months. Intraoperative micro-perforation occurred in 2 eyes (9.5%); however, there was no shift to penetrating keratoplasty. Air-bubble temponade was performed in 7 eyes (33.3%) for post-operative gapping of the graft. There were 2 failed grafts (9.5%) due to corneal ulcer; while all the other grafts remained clear. The mean pre-operative best corrected visual acuity was 1.84 �Â�± 0.66 logMAR, which improved to 0.74 �Â�± 0.63 (p<0.01). The average sphere power was -0.88 �Â�± 3.88 diopter (D), average cylinder power 3.03 �Â�± 1.46 D, and average endothelial count 1877 �Â�± 375 cells/mm2.


In severe ocular surface diseases, big-bubble technique frequently failed to separate pre-descemtic plane; however, it effectively created air-filled stroma which was easier to remove. Although best corrected visual acuity was suboptimal due to ocular surface disorders, graft survival and clarity rate is high, justifying the application of DALK in these cases.

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