Performing DALK complicated by Descemet's membrane macroperforation in keratoconus without conversion to penetrating keratoplasty: a case report
We report a case of successful deep anterior lamellar keratoplasty (DALK) for kearatoconus in the presence of intraoperative Descemet's membrane (DM) macroperforation in a 10-year boy. Intraoperative optical coherence tomography–guided femtosecond laser-assisted DM separation from the periphery...
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| Format: | Article |
| Language: | English |
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Ukrainian Society of Ophthalmologists
2022-04-01
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| Series: | Journal of Ophthalmology |
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| Online Access: | https://www.ozhurnal.com/en/archive/2022/2/10-fulltext |
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| author | V. N. Serdiuk N. G. Klopotskaya S. B. Ustimenko Ye. N. Maidenko Ye. B. Storozhenko V. V. Tikhomirova |
| author_facet | V. N. Serdiuk N. G. Klopotskaya S. B. Ustimenko Ye. N. Maidenko Ye. B. Storozhenko V. V. Tikhomirova |
| author_sort | V. N. Serdiuk |
| collection | DOAJ |
| description | We report a case of successful deep anterior lamellar keratoplasty (DALK) for kearatoconus in the presence of intraoperative Descemet's membrane (DM) macroperforation in a 10-year boy. Intraoperative optical coherence tomography–guided femtosecond laser-assisted DM separation from the periphery to the center facilitated keeping the anterior chamber angle open and avoiding a subsequent increase in intraocular pressure. In addition, the size of the graft was made 0.4 mm larger that the size of the trephination hole, which enabled fitting of the graft margins and trephination margins, whereas precise deep femtosecond laser corneal dissection enabled (a) preventing a shock wave effect from the laser pulses and (b) DM adherence to the stroma of the graft. At 5 months after surgery, uncorrected visual acuity (UCVA) was 0.5; keratometry values OD were R1, 7.67 mm; К1, 44.0 D; R2, 7.30 mm; К2, 46.2 D; Rm, 7.48 mm; Km, 45.1 D; and Astig, 2.2 D. Anterior chamber angle was 41.4º. The DM adhered well to the donor stroma, the DM defect was practically not visualized on imaging, and endothelial cell density was 2719 cells/mm2 in the operated eye. At 7 months after surgery, the patient’s UCVA was 0.6 OD and corrected visual acuity with a spherical equivalent of +3.0 D was 0.9. |
| first_indexed | 2024-03-11T19:41:08Z |
| format | Article |
| id | doaj.art-08ca8563f3b04c32b978c018fc90db9c |
| institution | Directory Open Access Journal |
| issn | 2412-8740 |
| language | English |
| last_indexed | 2024-03-11T19:41:08Z |
| publishDate | 2022-04-01 |
| publisher | Ukrainian Society of Ophthalmologists |
| record_format | Article |
| series | Journal of Ophthalmology |
| spelling | doaj.art-08ca8563f3b04c32b978c018fc90db9c2023-10-06T09:08:48ZengUkrainian Society of OphthalmologistsJournal of Ophthalmology2412-87402022-04-0125456http://doi.org/10.31288/oftalmolzh202225456Performing DALK complicated by Descemet's membrane macroperforation in keratoconus without conversion to penetrating keratoplasty: a case reportV. N. Serdiuk0N. G. Klopotskaya1S. B. Ustimenko2Ye. N. Maidenko3Ye. B. Storozhenko4V. V. Tikhomirova 5Dnipro State Medical University; Dnipro (Ukraine)Dnipro State Medical University; Dnipro (Ukraine)Dnipropetrovsk Regional Clinical Ophthalmological Hospital; Dnipro (Ukraine)Dnipropetrovsk Regional Clinical Ophthalmological Hospital; Dnipro (Ukraine)Dnipropetrovsk Regional Clinical Ophthalmological Hospital; Dnipro (Ukraine)Dnipropetrovsk Regional Clinical Ophthalmological Hospital; Dnipro (Ukraine)We report a case of successful deep anterior lamellar keratoplasty (DALK) for kearatoconus in the presence of intraoperative Descemet's membrane (DM) macroperforation in a 10-year boy. Intraoperative optical coherence tomography–guided femtosecond laser-assisted DM separation from the periphery to the center facilitated keeping the anterior chamber angle open and avoiding a subsequent increase in intraocular pressure. In addition, the size of the graft was made 0.4 mm larger that the size of the trephination hole, which enabled fitting of the graft margins and trephination margins, whereas precise deep femtosecond laser corneal dissection enabled (a) preventing a shock wave effect from the laser pulses and (b) DM adherence to the stroma of the graft. At 5 months after surgery, uncorrected visual acuity (UCVA) was 0.5; keratometry values OD were R1, 7.67 mm; К1, 44.0 D; R2, 7.30 mm; К2, 46.2 D; Rm, 7.48 mm; Km, 45.1 D; and Astig, 2.2 D. Anterior chamber angle was 41.4º. The DM adhered well to the donor stroma, the DM defect was practically not visualized on imaging, and endothelial cell density was 2719 cells/mm2 in the operated eye. At 7 months after surgery, the patient’s UCVA was 0.6 OD and corrected visual acuity with a spherical equivalent of +3.0 D was 0.9.https://www.ozhurnal.com/en/archive/2022/2/10-fulltextdeep anterior lamellar keratoplastydescemet's membrane macroperforation |
| spellingShingle | V. N. Serdiuk N. G. Klopotskaya S. B. Ustimenko Ye. N. Maidenko Ye. B. Storozhenko V. V. Tikhomirova Performing DALK complicated by Descemet's membrane macroperforation in keratoconus without conversion to penetrating keratoplasty: a case report Journal of Ophthalmology deep anterior lamellar keratoplasty descemet's membrane macroperforation |
| title | Performing DALK complicated by Descemet's membrane macroperforation in keratoconus without conversion to penetrating keratoplasty: a case report |
| title_full | Performing DALK complicated by Descemet's membrane macroperforation in keratoconus without conversion to penetrating keratoplasty: a case report |
| title_fullStr | Performing DALK complicated by Descemet's membrane macroperforation in keratoconus without conversion to penetrating keratoplasty: a case report |
| title_full_unstemmed | Performing DALK complicated by Descemet's membrane macroperforation in keratoconus without conversion to penetrating keratoplasty: a case report |
| title_short | Performing DALK complicated by Descemet's membrane macroperforation in keratoconus without conversion to penetrating keratoplasty: a case report |
| title_sort | performing dalk complicated by descemet s membrane macroperforation in keratoconus without conversion to penetrating keratoplasty a case report |
| topic | deep anterior lamellar keratoplasty descemet's membrane macroperforation |
| url | https://www.ozhurnal.com/en/archive/2022/2/10-fulltext |
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