Novel Technique For The Management Of Macroperforation During Deep Anterior Lamellar Keratoplasty

Ayman Nasr Hashem,1 Sherif Said Tolees,2 Ahmed Samir3 1Eye City Hospital, Cairo, Egypt; 2Magrabi Eye and Ear Hospital, Jeddah, KSA; 3Faculty of Medicine, Zagazig University, Zagazig, Egypt Correspondence: Ayman Nasr HashemEye City Hospital, Fifth Settlement, Cairo, EgyptTel +2 01009769598Email ayman...

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Autores principales:	Nasr Hashem A, Tolees SS, Samir A
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	DALK keratoplasty corneal transplant stromal patch suturing technique macroperforation Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/03416257df184b26b195245e931baa39
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spelling	oai:doaj.org-article:03416257df184b26b195245e931baa392021-12-02T08:18:35ZNovel Technique For The Management Of Macroperforation During Deep Anterior Lamellar Keratoplasty1177-5483https://doaj.org/article/03416257df184b26b195245e931baa392019-10-01T00:00:00Zhttps://www.dovepress.com/novel-technique-for-the-management-of-macroperforation-during-deep-ant-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Ayman Nasr Hashem,1 Sherif Said Tolees,2 Ahmed Samir3 1Eye City Hospital, Cairo, Egypt; 2Magrabi Eye and Ear Hospital, Jeddah, KSA; 3Faculty of Medicine, Zagazig University, Zagazig, Egypt Correspondence: Ayman Nasr HashemEye City Hospital, Fifth Settlement, Cairo, EgyptTel +2 01009769598Email aymannhashem@gmail.comPurpose: To describe the outcomes of a case series of patients who underwent a novel technique for managing macroperforation during deep anterior lamellar keratoplasty (DALK).Methods: Nine eyes of 9 patients with advanced keratoconus who underwent DALK comprised the case series. A macroperforation occurred in all eyes during DALK. The stromal patch suturing technique was used to manage all cases; a large piece of the previously excised stromal tissue was sutured to the edge of the trephine to seal the perforation. The technical aspects of the procedure are described and data are presented on the visual outcomes, endothelial microscopy, and postoperative complications at last postoperative visit (average 18 months; range, 7 to 23 months).Results: All 9 cases were managed successfully with the stromal patch suturing technique. Postoperatively, the graft was clear in all cases. At day 1, seven eyes had a Descemet’s membrane detachment, 3 of these eyes resolved spontaneously within 2 weeks and 4 required air bubble injection for successful reattachment. At last follow up seven eyes had a corrected distance visual acuity of 20/30 or better and 2 eyes had 20/40 vision. The average endothelial cell count was 2162 cell/mm2. There were no cases with excessive inflammation or vascularisation during the postoperative follow-up.Conclusion: The stromal patch suturing technique was successfully used to manage intraoperative macroperforation during DALK. This technique resulted in endothelial changes that were consistent with uncomplicated DALK and function visual acuity of 20/40 or better in all cases with no postoperative sequelae.Keywords: DALK, keratoplasty, corneal transplant, stromal patch suturing technique, macroperforationNasr Hashem ATolees SSSamir ADove Medical PressarticleDALKkeratoplastycorneal transplantstromal patch suturing techniquemacroperforationOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 13, Pp 2075-2080 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	DALK keratoplasty corneal transplant stromal patch suturing technique macroperforation Ophthalmology RE1-994
spellingShingle	DALK keratoplasty corneal transplant stromal patch suturing technique macroperforation Ophthalmology RE1-994 Nasr Hashem A Tolees SS Samir A Novel Technique For The Management Of Macroperforation During Deep Anterior Lamellar Keratoplasty
description	Ayman Nasr Hashem,1 Sherif Said Tolees,2 Ahmed Samir3 1Eye City Hospital, Cairo, Egypt; 2Magrabi Eye and Ear Hospital, Jeddah, KSA; 3Faculty of Medicine, Zagazig University, Zagazig, Egypt Correspondence: Ayman Nasr HashemEye City Hospital, Fifth Settlement, Cairo, EgyptTel +2 01009769598Email aymannhashem@gmail.comPurpose: To describe the outcomes of a case series of patients who underwent a novel technique for managing macroperforation during deep anterior lamellar keratoplasty (DALK).Methods: Nine eyes of 9 patients with advanced keratoconus who underwent DALK comprised the case series. A macroperforation occurred in all eyes during DALK. The stromal patch suturing technique was used to manage all cases; a large piece of the previously excised stromal tissue was sutured to the edge of the trephine to seal the perforation. The technical aspects of the procedure are described and data are presented on the visual outcomes, endothelial microscopy, and postoperative complications at last postoperative visit (average 18 months; range, 7 to 23 months).Results: All 9 cases were managed successfully with the stromal patch suturing technique. Postoperatively, the graft was clear in all cases. At day 1, seven eyes had a Descemet’s membrane detachment, 3 of these eyes resolved spontaneously within 2 weeks and 4 required air bubble injection for successful reattachment. At last follow up seven eyes had a corrected distance visual acuity of 20/30 or better and 2 eyes had 20/40 vision. The average endothelial cell count was 2162 cell/mm2. There were no cases with excessive inflammation or vascularisation during the postoperative follow-up.Conclusion: The stromal patch suturing technique was successfully used to manage intraoperative macroperforation during DALK. This technique resulted in endothelial changes that were consistent with uncomplicated DALK and function visual acuity of 20/40 or better in all cases with no postoperative sequelae.Keywords: DALK, keratoplasty, corneal transplant, stromal patch suturing technique, macroperforation
format	article
author	Nasr Hashem A Tolees SS Samir A
author_facet	Nasr Hashem A Tolees SS Samir A
author_sort	Nasr Hashem A
title	Novel Technique For The Management Of Macroperforation During Deep Anterior Lamellar Keratoplasty
title_short	Novel Technique For The Management Of Macroperforation During Deep Anterior Lamellar Keratoplasty
title_full	Novel Technique For The Management Of Macroperforation During Deep Anterior Lamellar Keratoplasty
title_fullStr	Novel Technique For The Management Of Macroperforation During Deep Anterior Lamellar Keratoplasty
title_full_unstemmed	Novel Technique For The Management Of Macroperforation During Deep Anterior Lamellar Keratoplasty
title_sort	novel technique for the management of macroperforation during deep anterior lamellar keratoplasty
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/03416257df184b26b195245e931baa39
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Novel Technique For The Management Of Macroperforation During Deep Anterior Lamellar Keratoplasty

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