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Rasik Vajpayee, Prafulla Maharana, Namrata Sharma; Diamond knife assisted Deep Anterior Lamellar Keratoplasty (Dia-DALK): A new surgical technique for management of Keratoconus. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1750.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate outcomes of our new technique of DALK in cases of Keratoconus
DALK was performed in 20 Keratoconic eyes using our technique of Dia-DALK. The technique involved marking the host cornea with a 8-8.5 mm trephine and performing an intraoperative pachymetry along that mark at about 11 O'Clock. Subsequently, diamond knife set at a depth 40µ less than that of pachymetry reading was used to make an incision of 2mm at 11 O'Clock position. This incision at that depth was then enlarged with the help of curved Vannas scissors circumferentially and a blunt lamellar dissector was used to dissect and remove the overlying stromal layers radially. A 0.25 mm oversized donor button whose descemet membrane had been scrapped off, was sutured on the host bed. Main outcome measures analysed were BCVA, keratometry (Km), spherical equivalent (SEQ) and endothelial cell density.
At 6 month the mean residual host thickness was 41.7± 13.8µ. The mean log MAR BCVA improved significantly from preoperative value of 1.847±0.289 to 0.2117±0.061 (p= 0.005).The average Km improved from 66.5±7.5D to 45.1±1.5D (p=0.03). The mean SEQ decreased from -7.8 ±4.6D to -1.23±0.88 D (p=0.007). A significant decrease was seen in refractive astigmatism from 5.93 ±3.06D preoperatively to 3.23 ±1.14D (p=0.037). The mean endothelial cell loss was 5.241+3.6 %. No intraoperative perforations occurred in any of the cases.
Our technique of Dia-DALK is safe, predictable and effective for the mangement of Keratoconus. It has the potential to become an alternative to Big Bubble DALK
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