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Intraoperative perforation of Descemet's membrane during “big bubble” deep anterior lamellar keratoplasty

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Abstract

To analyze the reasons for intraoperative perforation of Descemet's membrane during deep anterior lamellar keratoplasty (DALK) during the learning curve. DALK was attempted in 35 eyes of 33 patients with pathologies involving the corneal stroma and sparing of Descemet's membrane (DM), including patients with keratoconus, corneal stromal dystrophies and healed keratitis. The surgical plan included complete removal of the corneal stroma using the “big bubble” technique for exposing Descemet's membrane followed by grafting of a full-thickness corneal stromal lenticule. DALK was converted into full-thickness penetrating keratoplasty in eight eyes (23%), which included patients with keratoconus (n = 6), macular corneal dystrophy (n = 1) and healed keratitis (n = 1). Main reasons for conversion were perforation of the DM due to excessive air injection (four eyes) and improper surgical maneuvers (three eyes). One case had deposits on Descemet's membrane upon exposure of the DM. A successful penetrating keratoplasty could be performed in all eight eyes. During the learning curve, excessive air injection and inappropriate surgical maneuvers may complicate a DALK resulting in conversion to penetrating keratoplasty.

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References

  1. Anwar M, Teichmann KD (2002) Big-bubble technique to bare Descemet’s membrane in anterior lamellar keratoplasty. J Cataract Refract Surg 28:398–403

    Article  PubMed  Google Scholar 

  2. Shimmura S, Tsubota K (2006) Deep anterior lamellar keratoplasty. Curr Opin Ophthalmol 17:349–355

    Article  PubMed  Google Scholar 

  3. Al-Torbak AA, Al-Motowa S, Al-Assiri A et al (2006) Deep anterior lamellar keratoplasty for keratoconus. Cornea 25:408–412

    PubMed  Google Scholar 

  4. Pakrou N, Fung S, Selva D, Chehade M, Leibovitch I (2006) Deep anterior lamellar keratoplasty in the treatment of keratoconus. Ophthalmologica 220:164–169

    Article  PubMed  Google Scholar 

  5. Fournie P, Coullet J, Moalic S, Malecaze F, Chapotot E, Arne JL (2006) Deep anterior lamellar keratoplasty in the surgical treatment of keratoconus. A 1-year follow-up. J Fr Ophthalmol 29:602–613

    Article  CAS  Google Scholar 

  6. Vabres B, Bosnjakowski M, Bekri L, Weber M, Pechereau A (2006) Deep lamellar keratoplasty versus penetrating keratoplasty for keratoconus. J Fr Ophthalmol 29:361–371

    Article  CAS  Google Scholar 

  7. Vajpayee RB, Tyagi J, Sharma N, Kumar N, Jhanji V, Titiyal JS (2007) Deep anterior lamellar keratoplasty by big-bubble technique for treatment corneal stromal opacities. Am J Ophthalmol 143:954–957

    Article  PubMed  Google Scholar 

  8. Wylegala E, Wroblewska EM, Tarnawska D, Mierzwa M (2003) Applying deep lamellar keratoplasty in corneal disorders without endothelial abnormalities. Klin Oczna 105:263–266

    PubMed  Google Scholar 

  9. Michieletto P, Balestrazzi A, Balestrazzi A, Mazzotta C, Occhipinti I, Rossi T (2006) Factors predicting unsuccessful big bubble deep lamellar anterior keratoplasty. Ophthalmologica 220:379–382

    Article  PubMed  Google Scholar 

  10. Fogla R, Padmanabhan P (2006) Results of deep lamellar keratoplasty using the big-bubble technique in patients with keratoconus. Am J Ophthalmol 141:254–259

    Article  PubMed  Google Scholar 

  11. Anwar M, Teichmann KD (2002) Big bubble technique to bare Descemet’s membrane in anterior lamellar keratoplasty. J Cataract Refract Surg 28:398–403

    Article  PubMed  Google Scholar 

  12. Fontana L, Parente G, Tassinari G (2007) Clinical outcomes after deep anterior lamellar keratoplasty using the big-bubble technique in patients with keratoconus. Am J Ophthalmol 143:117–124

    Article  PubMed  Google Scholar 

  13. Leccisotti A (2007) Descemet’s membrane perforation during deep anterior lamellar keratoplasty: prognosis. J Cataract Refract Surg 33:825–829

    Article  PubMed  Google Scholar 

  14. Parthasarathy A, Por YM, Tan DT (2008) Using a “small bubble technique” to aid in success in Anwar’s “big bubble technique” of deep lamellar keratoplasty with complete baring of Descemet’s membrane. Br J Ophthalmol 92(3):422

    Article  PubMed  Google Scholar 

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Correspondence to Vishal Jhanji.

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Jhanji, V., Sharma, N. & Vajpayee, R.B. Intraoperative perforation of Descemet's membrane during “big bubble” deep anterior lamellar keratoplasty. Int Ophthalmol 30, 291–295 (2010). https://doi.org/10.1007/s10792-009-9334-7

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  • DOI: https://doi.org/10.1007/s10792-009-9334-7

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