Intraoperative perforation of Descemet's membrane during "big bubble" deep anterior lamellar keratoplasty

被引：32
作者：
Jhanji V. [1 ]
Sharma N. [2 ]
Vajpayee R.B. [1 ,2 ]
机构：
[1] Centre for Eye Research Australia, University of Melbourne, Melbourne
[2] Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences
来源：
International Ophthalmology | 2010年 / 30卷 / 3期
关键词：
Air injection; Big bubble deep anterior lamellar keratoplasty; Deep anterior lamellar keratoplasty; Descemet's membrane perforation; Lamellar keratoplasty; Penetrating keratoplasty;
D O I：
10.1007/s10792-009-9334-7
中图分类号：
学科分类号：
摘要：
To analyze the reasons for intraoperative perforation of Descemet's membrane during deep anterior lamellar keratoplasty (DALK) during the learning curve. DALK was attempted in 35 eyes of 33 patients with pathologies involving the corneal stroma and sparing of Descemet's membrane (DM), including patients with keratoconus, corneal stromal dystrophies and healed keratitis. The surgical plan included complete removal of the corneal stroma using the "big bubble" technique for exposing Descemet's membrane followed by grafting of a full-thickness corneal stromal lenticule. DALK was converted into full-thickness penetrating keratoplasty in eight eyes (23%), which included patients with keratoconus (n = 6), macular corneal dystrophy (n = 1) and healed keratitis (n = 1). Main reasons for conversion were perforation of the DM due to excessive air injection (four eyes) and improper surgical maneuvers (three eyes). One case had deposits on Descemet's membrane upon exposure of the DM. A successful penetrating keratoplasty could be performed in all eight eyes. During the learning curve, excessive air injection and inappropriate surgical maneuvers may complicate a DALK resulting in conversion to penetrating keratoplasty. © Springer Science+Business Media B.V. 2009.
引用
收藏
页码：291 / 295
页数：4
相关论文
共 14 条
  • [1] Anwar M., Teichmann K.D., Big-bubble technique to bare Descemet's membrane in anterior lamellar keratoplasty, J Cataract Refract Surg, 28, pp. 398-403, (2002)
  • [2] Shimmura S., Tsubota K., Deep anterior lamellar keratoplasty, Curr Opin Ophthalmol, 17, pp. 349-355, (2006)
  • [3] Al-Torbak A.A., Al-Motowa S., Al-Assiri A., Et al., Deep anterior lamellar keratoplasty for keratoconus, Cornea, 25, pp. 408-412, (2006)
  • [4] Pakrou N., Fung S., Selva D., Chehade M., Leibovitch I., Deep anterior lamellar keratoplasty in the treatment of keratoconus, Ophthalmologica, 220, pp. 164-169, (2006)
  • [5] Fournie P., Coullet J., Moalic S., Malecaze F., Chapotot E., Arne J.L., Deep anterior lamellar keratoplasty in the surgical treatment of keratoconus. A 1-year follow-up, J Fr Ophthalmol, 29, pp. 602-613, (2006)
  • [6] Vabres B., Bosnjakowski M., Bekri L., Weber M., Pechereau A., Deep lamellar keratoplasty versus penetrating keratoplasty for keratoconus, J Fr Ophthalmol, 29, pp. 361-371, (2006)
  • [7] Vajpayee R.B., Tyagi J., Sharma N., Kumar N., Jhanji V., Titiyal J.S., Deep anterior lamellar keratoplasty by big-bubble technique for treatment corneal stromal opacities, Am J Ophthalmol, 143, pp. 954-957, (2007)
  • [8] Wylegala E., Wroblewska E.M., Tarnawska D., Mierzwa M., Applying deep lamellar keratoplasty in corneal disorders without endothelial abnormalities, Klin Oczna, 105, pp. 263-266, (2003)
  • [9] Michieletto P., Balestrazzi A., Balestrazzi A., Mazzotta C., Occhipinti I., Rossi T., Factors predicting unsuccessful big bubble deep lamellar anterior keratoplasty, Ophthalmologica, 220, pp. 379-382, (2006)
  • [10] Fogla R., Padmanabhan P., Results of deep lamellar keratoplasty using the big-bubble technique in patients with keratoconus, Am J Ophthalmol, 141, pp. 254-259, (2006)
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