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Case Reports
. 2022 Aug 19;15(8):e246124.
doi: 10.1136/bcr-2021-246124.

Case series of staged lamellar corneal grafting with thin manual Descemet's stripping endothelial keratoplasty, followed by manual deep anterior lamellar keratoplasty, as an alternative to penetrating keratoplasty

Abdo Karim Tourkmani  1 , Eleanor McCance  2 , Abdus Samad Ansari  2 , David F Anderson  3
Affiliations
Case Reports

Case series of staged lamellar corneal grafting with thin manual Descemet's stripping endothelial keratoplasty, followed by manual deep anterior lamellar keratoplasty, as an alternative to penetrating keratoplasty

Abdo Karim Tourkmani et al. BMJ Case Rep. .

Abstract

The purpose of this report is to present the outcomes of Descemet's stripping endothelial keratoplasty (DSEK), followed by deep anterior lamellar keratoplasty (DALK), as an alternative to penetrating keratoplasty (PKP) for different indications. Patients in this retrospective case series underwent manual DSEK, followed by manual DALK, for tectonic and/or visual reasons. It includes three cases that underwent DSEK followed by DALK as an alternative to PKP for the following conditions: failed PKP and stromal scarring, aphakic bullous keratopathy and herpetic stromal scarring, and herpetic corneal perforation. All cases had successful anatomical repair with visual improvement. Many corneal conditions involving endothelium and stroma have been traditionally managed with PKP. However, in certain settings with high risk of complications, this might not be an appropriate option. Therefore, for these cases, we propose management with DSEK followed by DALK as an alternative approach in a 'closed anterior chamber' fashion, which can reduce the risk of significant, sometimes irreversible, complications.

Keywords: Anterior chamber; Ophthalmology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Anterior segment slit lamp photos; (A) on presentation to our clinic, (B) post-Descemet’s stripping endothelial keratoplasty (DSEK) and (C) post-deep anterior lamellar keratoplasty over DSEK.
Figure 2
Figure 2
Anterior segment slit lamp photos case 2; (A) baseline (after intrascleral haptic tuck of three piece IOL, still pre-Descemet’s stripping endothelial keratoplasty (DSEK)), (B) post-DSEK and (C) post-deep anterior lamellar keratoplasty over DSEK.
Figure 3
Figure 3
Anterior segment slit lamp photos; (A) post-Descemet’s stripping endothelial keratoplasty (DSEK) day 7. Note excellent tectonic outcome from DSEK (B) 3 weeks post-DSEK. Note melting of host stromal tissue extending beyond the edges of DSEK lenticule and (C) post-deep anterior lamellar keratoplasty over DSEK.
See this image and copyright information in PMC

References

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