NOVEL APPLICATION OF DEEP ANTERIOR LAMELLAR KERATOPLASTY FOR RETINAL DETACHMENT REPAIR IN TOTALLY OPAQUE CORNEA...

We present a novel approach for managing retinal detachment in a patient with aniridia-related corneal scarring precluding fundal view through a deep anterior lamellar keratoplasty.

A 30-year-old female patient who had bilaterally opaque cornea, due to advanced aniridia-related keratopathy presented with, experiencing flashing of light in her right eye. Examination of the retinal fundus was not possible because of the dense corneal scarring and underlying cataract. A superior bullous macula-off retinal detachment was diagnosed on ultrasonography. VA at presentation was hand motions. The corneal scarring extended to the mid-to-deep stroma. We performed a deep anterior lamellar dissection of the opacified corneal stroma, which allowed clear visualization of a dense cataract. The cataract was removed by phacoemulsification and intraocular lens (IOL) inserted. This allowed to proceeding with repair of retinal detachment through pars plana approach. The surgery was completed by a donor deep lamellar keratoplasty.

This achieved a good fundal view to proceed with phacovitrectomy visualized through the residual corneal layers. Uneventful pars plana vitrectomy, cryotherapy, and sulfur hexafluoride (SF6) gas were performed to reattach the retina. Postoperatively, the graft remains clear at 6 months with a VA of 20/160 in the right eye, a level of vision the patient had not experienced for decades.

Deep anterior lamellar keratoplasty offered an alternative to temporary keratoprosthesis to achieve a clear view of the retinal fundus and perform pars plana vitrectomy and repair of the retinal detachment.