Biomechanics in DALK: Big bubble vs manual lamellar dissection

Akdemir, Mehmet; Acar, Banu Torun; Acar, Suphi

doi:10.5935/0004-2749.20200022

Cited by 4 publications

(4 citation statements)

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“…Corneal hysteresis and resistance were similar in both groups, thus suggesting that manual lamellar dissection was not a disadvantage. 11 This suggests that manual delamination, as described in this study, can serve as a valid rescue for technical failures encountered during microkeratome preparations. Similarly, we have experienced corneal perforation in one graft due to deep manual delamination after the overestimation of thickness.…”

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confidence: 69%

Eye Bank Management of Irregular Descemet Stripping Automated Endothelial Keratoplasty Lenticules

Ruzza

Galeone

Baruzzo

et al. 2020

Cornea

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Purpose: To report the management of precut Descemet stripping automated endothelial keratoplasty (DSAEK) lenticules unsuitable for transplantation because of irregular anterior profile after microkeratome cutting. Methods:After preparation for DSAEK, 20 tissues were considered unsuitable for transplantation because of nonhomogeneous posterior stromal thickness. To convert them into suitable tissues for surgery, manual stromal delamination was performed by removing the excess stromal layers after the indications obtained through optical coherence tomography. These tissues were further transplanted as ultrathin DSAEK.Results: Nineteen tissues were delaminated successfully. The average reduction in thickness in the center (63 6 69 mm; P = 0.0101) and periphery (129 6 39 mm; P , 0.0001) before and after delamination was significantly different. One tissue showed signs of perforation during manual dissection and therefore considered unsuitable for transplantation. Primary graft failure was reported in one case, but it was not correlated with the tissue preparation. No other clinical complications were observed after surgery.Conclusions: Manual delamination of the stroma because of irregular microkeratome cutting is a viable option to obtain a uniform graft thickness required for DSAEK surgeries. This technique can further reduce tissue wastage that is observed after microkeratome cutting errors.

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confidence: 69%

Eye Bank Management of Irregular Descemet Stripping Automated Endothelial Keratoplasty Lenticules

Ruzza

Galeone

Baruzzo

et al. 2020

Cornea

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“…[ 7 ] Various studies had been reported henceforth comparing its outcome with other techniques of DALK. [ 16 18 19 20 ] Inferior visual outcome is reported in cases with residual posterior stromal tissue, especially in manual DALK. [ 16 18 19 20 ] Hence, BB DALK has become the preferred technique for DALK among experienced corneal surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…[ 16 18 19 20 ] Inferior visual outcome is reported in cases with residual posterior stromal tissue, especially in manual DALK. [ 16 18 19 20 ] Hence, BB DALK has become the preferred technique for DALK among experienced corneal surgeons. In the current study as well, BB DALK was the most preferred technique, followed by manual and viscoelastic assisted DALK.…”

Section: Discussionmentioning

confidence: 99%

Preferred practice pattern and observed outcome of deep anterior lamellar keratoplasty – A survey of Indian corneal surgeons

Fogla

Sahay

Sharma

2021

Indian J Ophthalmol

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Purpose: This study aimed to assess the preferred surgical technique and outcome of deep anterior lamellar keratoplasty (DALK) among corneal surgeons in India. Methods: An online questionnaire-based cross-sectional survey was conducted among members of the Cornea Society of India (CSI) with experience of performing >10 DALK procedure. The responses pertaining to their surgical experience, preferred technique, complications, and outcome of DALK were collected and analyzed. Results: A total of 156 responses were received. In total, 35.9% of participants reported annual keratoplasty of >50, and DALK constituted >25% surgeries for 25% of participants. Ectatic corneal disorder was reported as the most common indication for DALK by 71.6% of the respondents. Big-bubble (BB) DALK (W A -1.82) was the most preferred technique, along with suction trephine (50%) for partial trephination and bottom port cannula (45.5%) for BB formation. On statistical analysis, no difference was observed in the surgeon reported success rate of BB formation with or without anterior lamellar keratectomy (ALK) (χ2 (1,156) = 3.1498, P = 0.08) or paracentesis (χ2 (1,156) = 0.2737, P = 0.60) before stromal air injection, and method of stromal air injection (χ2 (1,156) = 4.7325, P = 0.09). Conversion to penetrating keratoplasty was reported by 16% of participants in >25% cases, while 66.7% reported in <10% cases. Cataract and double anterior chamber were the most common complications. 50% of participants suggested that >20 procedures are required to overcome the learning curve. Conclusion: BB DALK is the most commonly practiced DALK technique, and its success is independent of ALK and paracentesis being performed prior to air injection and method of air injection (cannula/needle).

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“…As a result, the resulting data have a large scatter and can only be used to a limited extent with various theoretical constructions in the clinical prediction of the behavior of a particular eye. Now in clinical practice, devices such as Ocular Response Analyzer (Reichert, Ophthalmic Instruments, USA) [1][2][3][4][5][6][7] and Corvis-ST (OCULUS, Optikgerate GmbH, Wetzlar, Germany) have found application [8][9][10][11]. Both devices (and their analogues) use a calibrated air flow to deform the cornea in the central region, and then analyze the movement of the cornea under its influence.…”

Section: Introductionmentioning

confidence: 99%

Study of Laser-Induced Microdeformations of the Cornea Using Phase-Sensitive Optical Coherent Elastography

Kasianenko

Golovchenko

Siplivyi

et al. 2022

J-BPE

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In many clinical cases, knowledge of the biomechanical properties of the cornea will allow for early diagnosis and also contribute to the success of treatment. The methods existing in the clinic characterize the biomechanical properties of the cornea as a whole, but do not give an idea of its local properties. One of the promising approaches to measure local changes in biomechanics is optical coherence elastography (OCE) based on phase-sensitive optical coherence tomography (OCT). In this work, the OCE method, based on the registration of small tissue deformations under an applied load, showed that the appearance and propagation of mechanical waves due to laser exposure depend on the loading of the studied biological tissue due to its tension with the application of various intraocular pressures (IOP). An analysis of inter-frame differential OCT images showed that the width of the laser impact zone on the tissue increases with increasing of IOP. An analysis of the strain amplitudes depending on the IOP at a given point revealed a correlation with the IOP value and made it possible to fix the fluidity threshold for the sample under consideration in the given experimental geometry.

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Biomechanics in DALK: Big bubble vs manual lamellar dissection

Cited by 4 publications

References 0 publications

Eye Bank Management of Irregular Descemet Stripping Automated Endothelial Keratoplasty Lenticules

Eye Bank Management of Irregular Descemet Stripping Automated Endothelial Keratoplasty Lenticules

Preferred practice pattern and observed outcome of deep anterior lamellar keratoplasty – A survey of Indian corneal surgeons

Study of Laser-Induced Microdeformations of the Cornea Using Phase-Sensitive Optical Coherent Elastography

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