Surgical Technique of Deep Anterior Lamellar Keratoplasty in Descemetoceles

Sharma, Namrata; Kumar, Chandrashekhar; Mannan, Rifat; Titiyal, Jeewan S; Vajpayee, Rasik B

doi:10.1097/ico.0b013e3181e2ef9c

Cited by 12 publications

(7 citation statements)

References 16 publications

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“…These component customized surgeries[5678] dedicated to different layers of the cornea have lesser complications as compared to open-sky procedures, hence are gaining popularity with the advancing technology.…”

Section: Resultsmentioning

confidence: 99%

Upgradation and modernization of eye banking services: Integrating tradition with innovative policies and current best practices

Tandon

Singh

Gupta

et al. 2017

Indian J Ophthalmol

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Purpose:The purpose of this study is to review the history and evolution of the National Eye Bank (NEB) and analyze the impact over the years and report the outcome of the invested resources.Methods:Review of archival material, records, project reports, policy and procedures' manuals, and publications was done. Descriptive and analytical processing of data obtained was undertaken. Parameters evaluated included total collection, transplantation, utilization rates of donor cornea, changing trends over time in terms of numbers and duration of recipients waiting, impactful research translated into changes in standard operating protocols, new facilities, and subsequent effects on numbers or quality assurance measures and overview of major achievements. Periodic situational analysis with contextual relevance and interpretation of outcomes was done pertaining to national goals and international standards.Results:The NEB and cornea services have played a key leadership role in furthering the development of eye banking and corneal transplantation services. The contribution extends beyond routine patient care to education, training, generation of resources, advocacy, and policymaking. In quantifiable terms, the overall performance has steadily increased over the years. Major contributions include training of doctors, eye bank staff and corneal surgeons, introduction of innovative techniques for corneal transplantation, setting of national standards for eye banking and provision of preservation media, customized corneal, and ocular surface cell replacement therapy in collaboration with other departments and institutes.Conclusion:The eye banking and corneal transplantation facilities have evolved with time providing quality services, modernized as appropriate with updated knowledge and incorporating technological advances supported by the systematic evidence-based approach.

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Section: Resultsmentioning

confidence: 99%

Upgradation and modernization of eye banking services: Integrating tradition with innovative policies and current best practices

Tandon

Singh

Gupta

et al. 2017

Indian J Ophthalmol

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“…DALK can be used to treat descemetocele if PDL is detected on OCT. Various studies have been published that denote the existence of descemetocele in cases of corneal melting and measures to prevent the eye from perforation,[ 6 7 8 ] but to the best of our knowledge, none of these studies have incorporated the application of OCT to assess the thickness of the residual corneal tissue that resists perforation. Although histopathology and electron microscopy are essential for documentation, it could not be performed for case 1 as DALK procedure was performed to reinforce the corneal integrity.…”

Section: Discussionmentioning

confidence: 99%

Predescemetocele: A distinct clinical entity

Narang

Agarwal

Kumar

2017

Indian J Ophthalmol

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The case report incorporates a Fourier-domain optical coherence tomography (OCT) examination for demonstration of the existence of pre-Descemet's layer (PDL; Dua's layer) overlying a descemetocele and demonstrates predescemetocele as a separate clinical entity. The prospective analysis was done in two cases that had descemetocele, and OCT demonstrated the presence of PDL over an unruptured descemetocele that offers resilience and can be treated with an elective deep anterior lamellar keratoplasty or a penetrating keratoplasty. A descemetocele, when covered with PDL, should be correctly designated as a predescemetocele. Loss of PDL leads to baring of Descemet's membrane that eventually ruptures.

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“…For DALK, viscoelastic-assisted dissection, previously described by us, was undertaken. [ 12 ] During keratoplasties performed for eyes with active infiltrates, an extra 0.25 mm margin was excised, and the host–donor disparity was maintained between 0.5 and 1 mm.…”

Section: Methodsmentioning

confidence: 99%

Management of descemetocele: Our experience and a simplified treatment algorithm

Shankar

Agarwal

Nagpal

et al. 2022

Indian Journal of Ophthalmology

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Purpose: To formulate a treatment algorithm for the management of descemetocele. Methods: This was a prospective interventional study that was conducted at a tertiary eye-care center. All consecutive cases of descemetocele during the study period (April 1, 2017–March 31, 2018) were evaluated for the following parameters: age, sex, previous medical or surgical therapy, risk factors, preexisting ocular diseases, location, site and size of descemetocele, interventions undertaken, visual acuity, and the fellow eye status. The surgical modalities and fellow eye status were correlated individually with therapeutic and functional outcomes, based on which a treatment algorithm was formulated. Results: The study included 24 eyes of 24 patients (19M, 5F) with a median age of presentation of 45 years. The mean follow-up duration was 6.79 ± 3.97 months (3–12 months). The most common cause of descemetocele was microbial keratitis (66.66%), and most cases were central (50%), small (58.33%), and non-perforated (79.16%). The surgical interventions undertaken were cyanoacrylate glue (CG, 37.5%), penetrating keratoplasty (PKP, 33.33%), patch graft (16.66%), and deep anterior lamellar keratoplasty (DALK, 12.5%). Therapeutic success was noted in 13/24 eyes (54.16%). Final visual acuity > 3/60 was seen in 25% cases. Suboptimal therapeutic ( P = 0.07) and visual ( P = 0.34) outcomes were noted in subjects with non-functional fellow eye. Conclusion: PKP was preferred for descemetoceles with active microbial keratitis and extensive infiltrates, while CG and DALK were undertaken for healed microbial keratitis, neurotrophic keratitis, and ocular surface disorders with partial limbal stem cell deficiency (LSCD). For total LSCD, amniotic membrane graft was preferred.

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Surgical Technique of Deep Anterior Lamellar Keratoplasty in Descemetoceles

Abstract: Viscoelastic-assisted DALK is a useful therapeutic option in selected cases of descemetocele after resolved microbial keratitis.

Cited by 12 publications

References 16 publications

Upgradation and modernization of eye banking services: Integrating tradition with innovative policies and current best practices

Upgradation and modernization of eye banking services: Integrating tradition with innovative policies and current best practices

Predescemetocele: A distinct clinical entity

Management of descemetocele: Our experience and a simplified treatment algorithm

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