DESCEMETIC DALK AND PREDESCEMETIC DALK : OUTCOMES IN 44 CASES

DR. NITESH NARAYENCORNEA AND REFRACTIVE SURGEON

MAXIVISIONHYDERABAD

THE AUTHOR HAS NO FINANCIAL INTEREST IN THE MATERIALS PRESENTED IN THIS POSTER

INDICATIONS FOR PD - DALK

POST HYDROPS SCAR INTRA- OP PERFORATION

PURPOSE

• To report the outcomes of our experience with deep anterior keratoplasty ( DALK) in patients with Keratoconus and other corneal opacities and dystrophies.

METHODS

• A retrospective evaluation of 47 eyes of 44 patients that have undergone DALK between 2011 and 2013 was done.

• We analysed the frequency of true Descemet membrane exposure (dDALK), and the number of eyes in which predescemetic plane (pdDALK)was achieved.

• Post operative visual acuity with mean spectacle power and central corneal thickness was evaluated in both the groups.

RESULTS

• A total of 17 of 47 (36.1%) of eyes were classified as dDALK.

• The indications of DALK included Keratoconus (78.72%), Post hydrops ( 8.5%), Corneal scar s/p HSV (4.24%), Post LASIK ectasia(2.12%), PMCD (2.12%), Spheroidal degeneration (2.12%).

• Descemet ruptures occurred in 4 of 47 cases (8.5%).

RESULTS

"@ 6 months" - pdDALK

"@ 6 months" - dDALK

"> 1 year" - pdDALK

"> 1 year" - dDALK

0

5

10

15

20

25

30

35

710

16

8

14 6

7

2

8

1

1

1

< 6/24"6/18-6/24'6/12'6/9'

RESULTSDALK PD - DALK P VALUE

BCVA @ 6 months( LOG mar )

0.2335 ± 0.087( 17 eyes )

0.348± 0.21( 30 eyes)

0.038

BCVA @ last follow up ( LOG mar)

0.221± 0.098 ( 11 eyes)

0.25± 0.23( 25 eyes)

0.692

Mean spectacle refractive error

- 2.242± 1.899( 17 eyes)

- 2.025 ± 3.14 ( 30 eyes)

0.79

Follow up( months)

12.88 ± 7.74 ( 17 eyes)

16.47 ± 8.32( 30 eyes)

0.152

Central corneal thickness

575 ± 38 microns ( 17 eyes)

593 ± 65 microns( 30 eyes)

0.303

Complications Amblyopia, Glaucoma

( underwent trabeculectomy)

Stromal rejection, suture infiltrate,

cataract ( 2 eyes)

STATISTICAL ANALYSIS – UNPAIRED t TEST

RESULTS

• Best spectacle corrected visual acuity (BSCVA) post operatively was alteast 20/40 in 89% of eyes at the patient’s last visit.

• There was no difference in visual acuity between the two groups at an average follow up of 15.2 months, although the eyes in dDALK group seemed to have faster visual recovery.

COMPLICATIONS IN PD - DALKSTROMAL REJECTION RESOLVED ON TOPICAL MEDICATIONS

SUTURE RELATED INFILTRATE RESOLVED WITH SCAR VA < 6/60

COMPLICATIONS

CATARACT AFTER CATARACT SURGERY

LITERATURE REVIEW

• In study by Abdeklkder et al 20 eyes of 20 patients were treated with DALK. dDALK was achieved in 12 eyes and a fine stromal layer was left in 8 eyes (pdDALK).

• No statistically significant difference in mean visual outcomes was found between the two groups.

• The reflectivity of keratocytes at the interface was more in pre-desemetic group which returned to normal in 10-12 weeks.

Abdelkder A et al, Descemetic versus pre-descemetic lamellar keratoplasty: Clinical and confocal study. Cornea 2011 Nov;30(11):1244-52

CONCLUSION

• Performing DALK, we had the greatest likelihood of reaching Descemet’s membrane with the Anwar Big Bubble technique.

• The visual outcomes are comparable to standard PK, avoiding the risk of endothelial rejection.

• The visual recovery in pdDALK is slower when compared to dDALK but the visual outcomes are comparable to dDALK and PK.