Massimo Busin1, Vincenzo Scorcia2, Pia Leon3, Yoav Nahum4. 1. Department of Ophthalmology, Ospedale Privato "Villa Igea," Forlì, Italy; IRFO (Istituto internazionale di Ricerca e Formazione in Oftalmologia), Forlì, Italy. Electronic address: mbusin@yahoo.com. 2. Department of Ophthalmology, University of "Magna Graecia," Catanzaro, Italy. 3. Department of Ophthalmology, Ospedale Privato "Villa Igea," Forlì, Italy; IRFO (Istituto internazionale di Ricerca e Formazione in Oftalmologia), Forlì, Italy. 4. Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Abstract
PURPOSE: To evaluate the outcomes of a new technique for deep anterior lamellar keratoplasty (DALK) employing the injection of air up to 2 mm inside a deep trephination (intended within 100 μm from the endothelial surface) obtained with a guarded trephine set by means of anterior segment optical coherence tomography (AS OCT). DESIGN: Retrospective, noncomparative, interventional case series. METHODS: The success rate and learning curve of pneumatic dissection in one clinical practice were analyzed in nonscarred keratoconic eyes undergoing a standardized DALK including 9-mm trephination intended to a depth within 100 μm from the endothelial surface, based on the thinnest AS OCT measurement at this site; and injection of air through a cannula advanced 1-2 mm centripetally from the bottom of the trephination. Surgical parameters, success rate of pneumatic dissection, and complications were recorded. RESULTS: Eighty-eight eyes of 88 patients were included in the study. Pneumatic dissection succeeded in 75 of 88 eyes (85%). No significant correlation could be found between number of cases performed and success rate for this surgeon. Complications included loss of suction during trephination (n = 2, 2.3%) and perforation (n = 4, 4.6%). Conversion to penetrating keratoplasty was necessary in 1 case (1.1%). CONCLUSION: Setting an adjustable trephine to a depth within 100 μm from the endothelial surface eliminates the need for reaching the central cornea for successful pneumatic dissection and substantially flattens the learning curve of DALK, while achieving a constant success rate above 80% and minimizing complications.
PURPOSE: To evaluate the outcomes of a new technique for deep anterior lamellar keratoplasty (DALK) employing the injection of air up to 2 mm inside a deep trephination (intended within 100 μm from the endothelial surface) obtained with a guarded trephine set by means of anterior segment optical coherence tomography (AS OCT). DESIGN: Retrospective, noncomparative, interventional case series. METHODS: The success rate and learning curve of pneumatic dissection in one clinical practice were analyzed in nonscarred keratoconic eyes undergoing a standardized DALK including 9-mm trephination intended to a depth within 100 μm from the endothelial surface, based on the thinnest AS OCT measurement at this site; and injection of air through a cannula advanced 1-2 mm centripetally from the bottom of the trephination. Surgical parameters, success rate of pneumatic dissection, and complications were recorded. RESULTS: Eighty-eight eyes of 88 patients were included in the study. Pneumatic dissection succeeded in 75 of 88 eyes (85%). No significant correlation could be found between number of cases performed and success rate for this surgeon. Complications included loss of suction during trephination (n = 2, 2.3%) and perforation (n = 4, 4.6%). Conversion to penetrating keratoplasty was necessary in 1 case (1.1%). CONCLUSION: Setting an adjustable trephine to a depth within 100 μm from the endothelial surface eliminates the need for reaching the central cornea for successful pneumatic dissection and substantially flattens the learning curve of DALK, while achieving a constant success rate above 80% and minimizing complications.
Authors: Neel D Pasricha; Christine Shieh; Oscar M Carrasco-Zevallos; Brenton Keller; David Cunefare; Jodhbir S Mehta; Sina Farsiu; Joseph A Izatt; Cynthia A Toth; Anthony N Kuo Journal: Cornea Date: 2016-11 Impact factor: 2.651
Authors: Mark Draelos; Gao Tang; Brenton Keller; Anthony Kuo; Kris Hauser; Joseph A Izatt Journal: IEEE Trans Biomed Eng Date: 2019-11-20 Impact factor: 4.538