ESCRS - P172 - DEEP ANTERIOR LAMELLAR KERATOPLASTY (DALK) TO RESCUE FAILED PENETRATING KERATOPLASTY

DEEP ANTERIOR LAMELLAR KERATOPLASTY (DALK) TO RESCUE FAILED PENETRATING KERATOPLASTY

Published 2022 - 26th ESCRS Winter Meeting

Reference: P172 | Type: Abstracts | DOI: 10.82333/c6bp-sp58

Authors: Ricardo Machado Soares* 1 , Carlos Lisa 2 , Luis Machado Fernández-Vega Cueto 3 , Belén Machado Alfonso 2 , Jose F. Alfonso 2

1Ophthalmology,Centro Hospitalar Vila Nova de Gaia e Espinho,Vila Nova de Gaia,Portugal, 2Ophthalmology,Fernández-Vega Ophthalmological Institute,Oviedo,Spain, 3Ophthalmology ,Fernández-Vega Ophthalmological Institute,Oviedo,Spain

Purpose

To describe the results of Deep anterior lamellar keratoplasty (DALK) to rescue failed Penetrating Keratoplasty (PK) grafts through a case series of patients highlighting particular clinical pearls of this procedure.

Setting

Fernández-Vega Ophthalmological Institute, Oviedo, Spain

Methods

Retrospective, case-series analysis of patients who underwent DALK to rescue PK graft failure (GF) due to anterior corneal pathologies. Patients could not present any signs of endothelial immunological allograft rejection, endothelial failure, or endothelial corneal scars and had a follow-up superior to 6 months. The main objective of the surgery, and primary outcome of this study, was the improvement of corneal transparency and best-corrected visual acuity (BCVA). Intra and postoperative complications or events during follow-up were also reported. Corneal topography (Sirius, CSO®, Italy), anterior segment optical coherence tomography, and corneal pachymetry (Casia SS-OCT version 2, Tomey®, Nagoya, Japan), specular microscopy (CEM-530, Nidek®, Japan) as well as patients’ surgery videos and anterior segment photographs, were obtained.

Results

Four eyes, three patients (51-63 years of age) were included in the study. Every patient achieved a significant improvement in corneal transparency and BCVA that lasted throughout the follow-up. Two intraoperative complications were observed: a small Descemet’s membrane peripheric micro-perforation in one patient, which was easily tamponaded, and an opening of the previous graft-host junction in another patient, which was readily solved by adding more sutures in that area.  During follow-up, no patient presented any signs of GF or graft rejection.

Conclusion

Repeated PK has a poorer prognosis compared to primary PK due to endothelial rejection. Our results suggest that DALK in these cases is surgically feasible. Lamellar surgery preserving a still healthy endothelium could be a promising approach for failed PK grafts due to anterior corneal pathologies. To our knowledge, our study is the first worldwide to report the use of DALK to rescue failed PK grafts.