Deep Anterior Lamellar Keratoplasty: Can All Ruptures Be Fixed?

Area of Science:

• Ophthalmology
• Corneal Surgery
• Lamellar Keratoplasty

Background:

• Descemet membrane (DM) ruptures can complicate deep anterior lamellar keratoplasty (DALK).
• Effective management strategies are crucial for successful DALK outcomes.
• Understanding rupture characteristics aids in surgical decision-making.

Purpose of the Study:

• To report the experience and outcomes of managing various Descemet membrane (DM) ruptures during deep anterior lamellar keratoplasty (DALK).
• To analyze the incidence, location, and repair strategies for DM ruptures in DALK.
• To evaluate postoperative results following DM rupture management in DALK.

Main Methods:

• Retrospective analysis of 1573 DALK procedures (2002-2017) with a minimum 24-month follow-up.
• Recorded DM rupture incidence, location, and surgical repair approach.
• Assessed visual acuity, endothelial cell loss, graft clarity, and complications in eyes with DM ruptures.

Main Results:

• DM ruptures occurred in 8.25% of eyes (119/1443), predominantly peripheral microruptures in manual DALK.
• Most ruptures (84%) resolved by postoperative day 1; 16% developed double anterior chamber, all resolved.
• No penetrating keratoplasty conversions were needed; graft clarity was high with minimal endothelial decompensation.

Conclusions:

• Attempting repair of all Descemet membrane (DM) ruptures in deep anterior lamellar keratoplasty (DALK) is recommended.
• Immediate conversion to penetrating keratoplasty for DM ruptures should be avoided.
• Knowledge of physiomechanical principles guides successful DM rupture management strategies in DALK.