Early Therapeutic Deep Anterior Lamellar Keratoplasty (Dalk) For Active Infective Keratitis Post Intra Corneal Ring Segments (Icrs) Implantation

To evaluate the possibility of doing DALK in active infection following ICRs and determine the proper timing of surgical intervention in these cases  

Memorial institute for ophthalmic research 

Uneventful bilateral ICRs was done  for treatment of  bilateral KC ,1^st  day postoperative  both eyes were quite slight redness no pain or discomfort , improvement of vision ,wound coapted and ring well positioned .2nd day the RT eye shows gapping of the wound and infiltration around the wound only .Moxifoxacin was given hourly for 12h, the infiltration  and gapping increased  reaching  to the edge of the ring .Ring was removed & tunnel washed with fortified ED. Fortified ED was given for 24 h with no response and increase of infiltration size to 7ml , corneal melting at the incision site nearly to  Descemet & starting anterior chamber reaction .Therapeutic DALK was decided with manual dissection  without any trial of air bubble injection.

First day postoperative , the graft was clear with no signs of infection .  Fortified eye drops as given for 1 week with steroid then shifted to Moxifoxacin after that and continued on our regular post DALK treatment regimen . The pt was followed up daily for the first week the weekly for 1 month there is no signs of recurrence and vision improved to 0.1 UCVA

Timing of surgical intervention in post ICR infections is very important as the infection starts in the deep layers of the cornea .Therapeutic DALK with manual dissection can be done in active infection.