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T. John, M. Milivojevic; Anterior Lamellar Keratoplasty With Fibrin Glue and Amniotic Membrane Transplantation in Corneal Melt, Descemetocele, With or Without Corneal Perforation. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1956.
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© ARVO (1962-2015); The Authors (2016-present)
To report the efficacy of automated anterior lamellar keratoplasty (ALK) using a microkeratome and an artificial anterior chamber, combined with fibrin glue and preserved human amniotic transplant (AMT) in the surgical management of corneal melt with Descemetocele, with or without corneal perforation.Setting/Venue: Operating room, Chicago, Illinois, U.S.A.
10 ALKs were performed in 8 eyes of 7 patients. Average age was 66 years (range=43-76 yrs.), with 5 females, OS= 6 eyes, and the majority was Caucasians (71%). Pre-operative diagnosis: Rheumatoid arthritis=3, diabetes mellitus=6, pellucid marginal degeneration=1(2eyes), Terrien’s marginal degeneration=1, s/p 3-failed penetrating keratoplasty (PKP) with AlphaCor=1, infective ulcer sterilized with frequent topical gatifloxacin drops=1. Findings included: corneal melt=100%, Descemetocele=86%, Perforation=71%. All surgeries were performed by one surgeon (T.J.). Type of anesthesia = topical with monitored anesthesia care (MAC) =90%, general anesthesia=10%. Surgical procedures: ALK=100%, AMT=100%, fibrin glue=100%, microkeratome and artificial anterior chamber=100%, donor disc thickness=170-370 µm.
Globe stabilization occurred in 100% of the eyes. None of the eyes showed pseudo-chamber formation. Fibrin glue resulted in uniform adherence of the donor disc to the host corneal crater created by the corneal melt in 100% of the eyes. There was rapid decrease in ocular inflammation associated with AMT use in 71% of eyes. Two patients underwent PKP when the eye became less inflamed and stable after ALK, namely, in 2 weeks (pt.1) and 3.5 weeks (pt. 2). Case(C#)/Pre-op/Post-op vision: C#1/LP/20/400; C#2/LP/HM; C#3/CF/20/50; C#4/20/25/20/25; C#5/LP/HM; C#6/LP/CF; C#7/HM/CF. Vision improved in 86% of eyes.
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