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. 2014 Apr;62(4):392-5.
doi: 10.4103/0301-4738.121108.

Modified deep anterior lamellar keratoplasty for the treatment of advanced keratoconus with steep corneal curvature to help in eliminating the wrinkles in the Descemet's membrane

Hamid Khakshoor, Alireza Eslampoor  1 , Saeed Shokoohi Rad, Amirhossein Vejdani
Affiliations

Modified deep anterior lamellar keratoplasty for the treatment of advanced keratoconus with steep corneal curvature to help in eliminating the wrinkles in the Descemet's membrane

Hamid Khakshoor et al. Indian J Ophthalmol. 2014 Apr.

Abstract

Aims: To determine the clinical efficacy of modified deep anterior lamellar keratoplasty (DALK) for the treatment of advanced-stage keratoconus with steep curvature.

Materials and methods: In this interventional, non-comparative case series, 30 patients with advanced stages of keratoconus and curvature of more than 60 D underwent a modified DALK procedure. In this technique, after big-bubble formation, posterior stromal lamella was cut and removed 5 mm centrally (baring Descemet's membrane completely) with posterior stromal layer remaining peripherally.

Results: The study included 30 eyes (30 patients with a mean ± SD age of 25 ± 5.4 years). The follow-up examination was performed for all participants up to 12 months after the surgery. The mean uncorrected visual acuity (UCVA) increased from 20/800 before the surgery to a subsequent 3/10 (P = 0.12). Likewise, best spectacle corrected visual acuity (BSCVA) improved, reaching 6/10 postoperatively (former quantity 20/200) (P = 0.18). In addition, mean keratometry and keratometric astigmatism managed to achieve considerable improvement, from 58.8 ± 5.4 D to 46.5 ± 2.1 D and 7.8 ± 2.1 to 4.54 ± 1.54 D, respectively (P = 0.52). Descemet's membrane wrinkling was not seen in any patient postoperatively.

Conclusions: This technique is effective in restoring acceptable vision and corneal regularity in advanced cases of keratoconus with a curvature more than 60 D who are also at risk of Descemet's membrane wrinkling after DALK. Therefore, this procedure could prevent from Descemet membrane wrinkling in such cases.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
DALK in a patient with steep curvature showing postoperative Descemet's membrane wrinkling and folding
Figure 2
Figure 2
Modified DALK in a patient with steep curvature showing no evidence of postoperative Descemet's membrane wrinkling and folding
See this image and copyright information in PMC

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