scholarly journals Descemetic and Predescemetic DALK in Keratoconus Patients: A Clinical and Confocal Perspective Study

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Domenico Schiano-Lomoriello ◽  
Rossella Annamaria Colabelli-Gisoldi ◽  
Mario Nubile ◽  
Francesco Oddone ◽  
Giorgio Ducoli ◽  
...  
Keyword(s):  
Confocal Microscopy ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Layer By Layer ◽  
In Vivo Confocal Microscopy ◽  
Descemet Membrane ◽  
Anterior Lamellar Keratoplasty ◽  
A Minor ◽  
Big Bubble

Purpose. To evaluate the clinical outcomes and in vivo confocal microscopy (IVCM) features of keratoconus patients who underwent deep anterior lamellar keratoplasty (DALK).Methods. DALK was performed using the big bubble technique in all the patients. If the bubble was not successful to bare the descemet membrane, a manual dissection layer-by layer was performed to expose a deep stromal plane close to the DM. The patients were divided in two groups depending on the intraoperative baring of the descemet membrane: predescemetic DALK (PD-DALK) and descemetic DALK (D-DALK) group.Results. One month after surgery the D-DALK patients show an increase of mean BCVA. In the PD-DALK group mean BCVA did not show significant improvement as compared to preoperative values. At 6 months after surgery mean BCVA was found to be similar in both groups. At 1 month IVCM the peak of reflectivity of the interface was lower in D-DALK group compared to PD-DALK. At 6 months the values of reflectivity were comparable.Conclusions. At 1 month D-DALK seems to lead to a minor interface reflectivity and to a better BCVA; these differences disappear after 6 months and the values of interface reflectivity and BCVA are comparable between D-DALK and PD-DALK.

Longitudinal changes in corneal leucocyte density in vivo following transplantation

2018 ◽  
Vol 103 (8) ◽  
pp. 1035-1041 ◽  
Author(s):  
Scott Hau ◽  
Bronagh Clarke ◽  
Caroline Thaung ◽  
Daniel F P Larkin
Keyword(s):  
Graft Rejection ◽  
Density Measurement ◽  
Topical Steroid ◽  
Steroid Treatment ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
In Vivo Confocal Microscopy ◽  
Post Transplant ◽  
Anterior Lamellar Keratoplasty

AimsTo prospectively evaluate the changes in corneal leucocyte density with in vivo confocal microscopy (IVCM) following transplantation and to determine if leucocyte density post-transplant is an indicator of graft rejection risk.MethodsIVCM imaging of cornea pre-transplant and post-transplant at 1 week, 1, 3 and 12 months. The changes in leucocyte density associated with diagnosis, vascularisation, type of keratoplasty, topical steroid and immunosuppression treatment, allograft rejection and failure within 4 years post-transplant were analysed.ResultsSub-basal nerve plexus total central leucocyte density (SBNP-TCLD) varied with diagnosis (p<0.001), interval post-transplant (p<0.001), degree of vascularisation (p=0.001) and rejection episodes in eyes off topical steroid (p=0.01). The highest SBNP-TCLD was found in eyes with inflammation pre-transplant. Mean 12-month SBNP-TCLD in eyes which had rejection episodes was almost double that in eyes which did not (79.0 and 39.8 cells/mm2, respectively). SBNP-TCLD >63.5 cells/mm2 was associated with a higher risk of rejection within 1 year (p=0.04) and 4 years (p=0.007). Changes in leucocyte density on the donor endothelium significantly differed between penetrating keratoplasty and deep anterior lamellar keratoplasty grafts (p<0.01) and in those in which rejection episodes were observed (p<0.001).ConclusionsLeucocyte density varies with corneal diagnosis, extent of vascularisation and interval post-transplant. Topical steroid treatment is associated with reduced leucocyte density and risk of graft rejection. Higher endothelium leucocyte density correlates significantly with previous or subsequent rejection episodes. Leucocyte density measurement by IVCM may be useful in identifying transplants at risk of rejection.

scholarly journals A Simple Technique for Descemet Membrane Exposure in Deep Anterior Lamellar Keratoplasty Using the Transconjunctival Single-plane Sclerocorneal Incision

2021 ◽  
Author(s):  
Takahiko Hayashi ◽  
Satoru Yamagami
Keyword(s):  
Penetrating Keratoplasty ◽  
Simple Technique ◽  
Case Series ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Single Plane ◽  
Descemet Membrane ◽  
Anterior Lamellar Keratoplasty ◽  
Membrane Exposure ◽  
Big Bubble

Abstract Background: To describe a simple technique for Descemet membrane exposure during deep anterior lamellar keratoplasty (DALK).Methods: As a prospective interventional case series, consecutive patients who underwent DALK were enrolled. The technique involved the separation of the Descemet membrane by injecting air and ophthalmic viscosurgical devices from the point where transconjunctival single-plane sclerocorneal incision with the slit knife is terminated prior to perforation using a mirror image. Descemet membrane exposure success rates and the incidence of intra- and postoperative complications were analyzed. Outcomes of successful DALK procedures, which were not converted to penetrating keratoplasty, were analyzed by evaluating best corrected visual acuity (BCVA; converted to logarithm of the minimum angle of resolution [logMAR]) and graft survival.Results: We included 11 eyes from 11 patients (seven males and four females; 53.6 ± 16.1 years; mean follow-up duration, 26.1 weeks [6–51 weeks]). Ten surgeries were successful in Descemet membrane exposure without rupture, eight were successful in big-bubble formation, and two were finally successful in Descemet membrane exposure after a failed big-bubble. The DALK procedure for only one eye was converted to a penetrating keratoplasty owing to a tear in the Descemet membrane. BCVA improved from 0.83 ± 0.38 logMAR preoperatively to 0.24 ± 0.12 logMAR postoperatively (n=10, p < 0.001). There was no primary graft failure.Conclusion: This simple technique of transconjunctival single-plane sclerocorneal incision could be very useful for exposing the Descemet membrane during DALK.

Management of Intra-Descemet Membrane Air Bubble in Big-Bubble Deep Anterior Lamellar Keratoplasty

Cornea ◽  
2013 ◽  
Vol 32 (9) ◽  
pp. 1193-1195 ◽  
Author(s):  
Namrata Sharma ◽  
Rishi Swarup ◽  
Shveta Jindal Bali ◽  
Prafulla Maharana ◽  
Jeewan S. Titiyal ◽  
...  
Keyword(s):  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Air Bubble ◽  
Descemet Membrane ◽  
Anterior Lamellar Keratoplasty ◽  
Big Bubble
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