Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov 15:16:3741-3749.
doi: 10.2147/OPTH.S382916. eCollection 2022.

Modified Deep Anterior Lamellar Keratoplasty Technique to Rescue Failed Penetrating Keratoplasty

Carlos Lisa #  1 , Ricardo Machado Soares #  2 , Luis Fernández-Vega-Cueto  1 , Belén Alfonso-Bartolozzi  1 , Jose F Alfonso  1
Affiliations

Modified Deep Anterior Lamellar Keratoplasty Technique to Rescue Failed Penetrating Keratoplasty

Carlos Lisa et al. Clin Ophthalmol. .

Abstract

Purpose: To describe a modified deep anterior lamellar keratoplasty (DALK) technique to rescue failed penetrating keratoplasty (PK) grafts and report its results.

Patients and methods: Retrospective, case-series analysis of patients who underwent modified DALK to rescue failed corneal grafts after PK was included. Every patient had corneal graft failure (GF) diagnosis due to anterior corneal (epithelium, Bowman's, and stroma layers) or refraction disorders uncorrectable with conservative management. The main objective of the surgery and primary outcome of the study was the improvement of corrected distance visual acuity (CDVA). The study's secondary outcome was the frequency of intra- and postoperative complications.

Results: This series included four eyes from three patients with a mean age of 57.7 years (range: 51-63 years). Mean follow-up of patients was thirteen months (range: 12-15 months). During follow-up, continuous improvement of corneal transparency and CDVA was observed in every patient. The only intraoperative complication reported was a peripheric DM microperforations of previous graft-host junction in two eyes. No signs of double anterior chamber, endothelial failure, GF, glaucoma, or other side effects were reported.

Conclusion: Our results suggest that modified DALK in patients with GF after PK, preserving a healthy endothelium, is surgically feasible. However, further studies are needed to compare this procedure to PK and other DALK technique variations.

Keywords: corneal diseases; corneal transplantation; graft failure; lamellar keratoplasty.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest in relation to this work. The authors do not have any financial disclosures or conflicts of interest to disclose. The authors alone are responsible for the writing and content of the article.

Figures

Figure 1
Figure 1
Images of patients eligible for deep anterior lamellar keratoplasty after graft failure after penetrating keratoplasty. (A) Small diameter and decentered graft with stromal opacification; (B) GF due to corneal neovascularization and stromal fibrosis.
Figure 2
Figure 2
Schematic diagram of the corneal wound after stromal dissection. (A) Note the progressively thinner stromal bed towards the center of the cornea and previous penetrating keratoplasty trephination (arrow). (B) Anterior-segment optical coherence tomography showing the result of the surgery. Note the white line delineating the corneal wound configuration.
Figure 3
Figure 3
Case 1 (A) Anterior segment photograph of the right eye revealing diminished corneal transparency due to central subepithelial and stromal fibrosis; (B) Linear microperforation in the donor-receptor area in the temporal side of the cornea noted during suturing (red arrow); (C) Postoperative status of the right eye – note the increased number of sutures around the donor-receptor opening (red arrow); (D) Anterior-segment optical coherence tomography showing a perfect apposition of the corneal graft.
Figure 4
Figure 4
Case 2 (A) Anterior segment photography of right eye displaying lipid keratopathy (with subepithelial and stromal fibrosis) and corneal neovascularization; (B) Preoperative anterior segment photography of the left eye revealing stromal fibrosis and corneal neovascularization; (C) Intraoperative complication during left eye surgery - linear peripheric microperforation between I and II hours in the previous donor-host region (red arrow); (D and E) Postoperative anterior segment photographs of the right and left eye, respectively. (F) Anterior-segment optical coherence tomography of both eyes – note the perfect apposition of the corneal graft. AS-OCT.
Figure 5
Figure 5
Case 3 (A) Preoperative anterior segment photo with diminished corneal transparency due to stromal fibrosis; (B) Graft after twelve months of surgery; (C) anterior-segment optical coherence tomography shows a perfect apposition between layers.
See this image and copyright information in PMC

References

    1. Zirm EK. Eine erfolgreiche totale Keratoplastik (A successful total keratoplasty). 1906. Refract Corneal Surg. 1989;5(4):258–261. doi:10.3928/1081-597X-19890701-12 - DOI - PubMed
    1. Crawford AZ, Patel DV, McGhee CN. A brief history of corneal transplantation: from ancient to modern. Oman J Ophthalmol. 2013;6(Suppl 1):S12. doi:10.4103/0974-620X.122289 - DOI - PMC - PubMed
    1. Dunker SL, Armitage WJ, Armitage M, et al. Practice patterns of corneal transplantation in Europe: first report by the European cornea and cell transplantation registry. J Cataract Refract Surg. 2021;47(7):865–869. doi:10.1097/J.JCRS.0000000000000574 - DOI - PubMed
    1. EBAA Eye banking statistical report 2019. Eye Bank Association America; 2020:1–110. Available from: www.restoresight.org. Accessed November 4, 2022.
    1. Patel NP, Kim T, Rapuano CJ, Cohen EJ, Laibson PR. Indications for and outcomes of repeat penetrating keratoplasty, 1989–1995. Ophthalmology. 2000;107(4):719–724. doi:10.1016/S0161-6420(00)00003-8 - DOI - PubMed

LinkOut - more resources