ESCRS - PO297 - Deep Anterior Lamellar Keratoplasty With A Lower Top-Hat In A Patient With An Inferior Corneal Ectasia

Deep Anterior Lamellar Keratoplasty With A Lower Top-Hat In A Patient With An Inferior Corneal Ectasia

Published 2022 - 40th Congress of the ESCRS

Reference: PO297 | Type: ESCRS 2022 - Posters | DOI: 10.82333/zkjm-4e61

Authors: Ferran Llanas Alegre 1 , Miriam Barbany Rodriguez* 1 , Irene Sassot Cladera 1

1Ophtalmology,Hospital Universitari Mútua de Terrassa,Terrassa,Spain

Purpose

We describe the case of a patient with pellucid marginal degeneration in both eyes, who underwent a DALK surgery and developed, after the retirement of all the corneal stitches, an inferior ectasia. It was decided to perform a new DALK with a lower top-hat in order to improve the thinning in the graft-receptor junction area

Setting

Hospital Universitari Mútua de Terrassa

Methods

We present the case of a patient who suffered from pellucid marginal degeneration in both eyes. As the patient did not tolerate the rigid lenses at all, we decided to perform a deep anterior lamellar keratoplasty(DALK) in the left eye. The result was satisfactory but when the sutures were removed in stages one year after the intervention, an inferior corneal ectasia was developed. It was decided to perform a new suture  of the DALK, but despite this, the ectasia progressed, presenting a significant thinning in the graft-receptor junction area. It was decided to perform a new DALK with a lower top-hat on the patient. 

Results

Corneal thickness was restored in the lower graft-receptor junction area, being almost indistinguishable from the thickness in the upper area. The graft integrated very well into the recipient stroma. The two overlapping folds of stroma were excellently coupled.

Conclusions

The usual corneal transplant techniques used in keratoconus are more complex to perform in the Pellucid Marginal Degeneration because it is necessary to perform large-diameter grafts to ensure that the affected peripheral cornea is completely removed. An incongruence between the thickness of the donor cornea and the thickness of the recipient cornea may occur at the lower periphery, which makes it more difficult to suture and which may limit the results of the procedure. In this case, performing a new DALK with a lower top hat made it possible to recover the thickness of the recipient cornea in the donor-recipient junction area.