Modified deep anterior lamellar keratoplasty for the treatment of advanced keratoconus with steep corneal curvature to help in eliminating the wrinkles in the Descemet's membrane.
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Date
2014-04
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Abstract
Aims: To determine the clinical efficacy of modified deep anterior lamellar keratoplasty (DALK) for
the treatment of advanced‑stage keratoconus with steep curvature. Materials and Methods: In this
interventional, non‑comparative case series, 30 patients with advanced stages of keratoconus and curvature
of more than 60 D underwent a modified DALK procedure. In this technique, after big‑bubble formation,
posterior stromal lamella was cut and removed 5 mm centrally (baring Descemet’s membrane completely)
with posterior stromal layer remaining peripherally. Results: The study included 30 eyes (30 patients with
a mean ± SD age of 25 ± 5.4 years). The follow‑up examination was performed for all participants up to
12 months after the surgery. The mean uncorrected visual acuity (UCVA) increased from 20/800 before the
surgery to a subsequent 3/10 (P = 0.12). Likewise, best spectacle corrected visual acuity (BSCVA) improved,
reaching 6/10 postoperatively (former quantity 20/200) (P = 0.18). In addition, mean keratometry and
keratometric astigmatism managed to achieve considerable improvement, from 58.8 ± 5.4 D to 46.5 ± 2.1
D and 7.8 ± 2.1 to 4.54 ± 1.54 D, respectively (P = 0.52). Descemet’s membrane wrinkling was not seen in
any patient postoperatively. Conclusions: This technique is effective in restoring acceptable vision and
corneal regularity in advanced cases of keratoconus with a curvature more than 60 D who are also at risk
of Descemet’s membrane wrinkling after DALK. Therefore, this procedure could prevent from Descemet
membrane wrinkling in such cases.
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Keywords
Keratoconus, modified deep anterior lamellar keratoplasty, steep corneal curvature
Citation
Khakshoor Hamid, Eslampoor Alireza, Shokoohi Rad Saeed, Vejdani Amirhossein. Modified deep anterior lamellar keratoplasty for the treatment of advanced keratoconus with steep corneal curvature to help in eliminating the wrinkles in the Descemet's membrane. Indian Journal of Ophthalmology. 2014 Apr ; 62 (4): 392-395.