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Victor A. Neamtu, James Chelnis, Hoon Jung, Jonathan Soh; Deep Anterior Lamellar Keratoplasty (DALK) With Intraoperative Descemet’s Tears Without Conversion To Penetrating Keratoplasty (PKP). Invest. Ophthalmol. Vis. Sci. 2012;53(14):17.
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To review cases of completed DALK with intraoperative Descemet's tear without conversion to PKP.
Case series of 3 eyes where DALK was performed for corneal ectasia. All operations were performed by one surgeon. All cases involved intraoperative Descemet’s tears. DALK was completed in all cases.
All cases carried the diagnosis of corneal ectasia. Cases 1 and 2 involved fellow eyes of a 41 year-old male with history of LASIK surgery 6 years prior to evaluation. Case 3 involved a 43 year old male with keratoconus who had intracorneal ring segments placed prior to evaluation. All 3 cases involved intraoperative Descemet’s membrane tears that were treated with intracameral air and supine positioning. Case 1 visual acuity (Va) at 42 months follow up was 20/50 (PH 20/30) with a clear graft. Case 2 Va at 5 months follow up was 20/70 (PH 20/40) with focal central edema. Case 3 Va at 12 months follow up was 20/40 with a clear graft. All 3 eyes had a linear or focal posterior scar at the site of rupture. Preoperative photos can be visualized in figure 1 (case 1 slit lamp and Pentacam, case 2 Orbscan, case 3 Orbscan). Postoperative photos are included in figure 2 (case 1 slit lamp and Pentacam, case 2 slit lamp and pachymetry, case 3 Orbscan and OCT).
DALK is an effective option for corneal ectasia and may be selectively utilized in cases of Descemet’s membrane tear without necessitating conversion to PKP.
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