Surgical Strategies To Manage Stromal Interface Irregularity Following Deep Anterior Lamellar Keratoplasty
Published 2024 - 42nd Congress of the ESCRS
Reference: PP16.06 | Type: Free paper | DOI: 10.82333/a8df-pj97
Authors: Alessandra Mancini* 1 , Andrea Lucisano 1 , Giuseppe Giannaccare 2 , Angely Christy Yu 3 , Andrea Taloni 1 , Rocco Pietropaolo 1 , Giovanna Carnovale Scalzo 1 , Adriano Carnevali 1 , Costanza Rossi 1 , Vincenzo Scorcia 1
1Department of Ophthalmology,University Magna Graecia of Catanzaro,Catanzaro,Italy, 2Eye Clinic, Department of Surgical Sciences,University of Cagliari,Cagliari,Italy, 3Department of Translational Medicine,University of Ferrara,Ferrara,Italy
Purpose
To describe the various surgical approaches to manage stromal interface irregularity following deep anterior lamellar keratoplasty (DALK).
Setting
This interventional case series conducted at the University Magna Graecia of Catanzaro included patients requiring repeat keratoplasty procedures for opacity and/or irregularity of the stromal interface after DALK.
Methods
The following surgical techniques with the aim of restoring transparency and regularity of central optical zone and improving visual acuity in eyes underwent unsuccessful DALK were performed:(1)simple anterior lamellar graft exchange;(2)repeat DALK with pneumatic dissection;(3)repeat DALK with deepening of manual lamellar dissection;(4)small diameter stripping of the central stroma-endothelium-Descemet complex and its replacement with a new endothelial lamella;(5)two-piece microkeratome-assisted mushroom penetrating keratoplasty.Uncorrected visual acuity, best-corrected visual acuity, slit lamp examination and anterior corneal tomography, were evaluated preoperatively, as well as 3, 6 and 12 months after surgery.Complications were recorded.
Results
Preoperative BCVA was less than 20/200 and improved to 20/40 or better in all cases, reaching 20/20 in one patient. Corneal clarity was restored in all eyes and no recurrence of underlying disease was observed. No intraoperative or postoperative complications were reported.
Conclusions
The present case series describe several successful surgical approaches to improve the transparency and regularity of stromal interface obtained after a DALK procedure; the choice of the technique should be customized for the single eyes to still maintain the advantages of lamellar or minimally invasive grafts.