Successful Deep Anterior Lamellar Keratoplasty in Pre-existing Descemet Membrane Perforation - A Case Series

Aim: To analyse the outcome of Deep anterior lamellar keratoplasty (DALK) in cases of pre-existing DM (Descemet membrane) tear. Method: 14 eyes with pre-existing perforation (4 eyes with advanced keratoconus post collagen crosslinking and post Toric implantable collamer lens explantation and 10 eyes with post healed hydrops) who underwent DALK were included. Manual layer by layer dissection by a special technique was employed. Results: Minimum follow up-1 year. All patients had good post-operative results with mean UCVA preoperative and postoperative value of 1.35±0.25 LogMAR and 0.68 ± 0.19 LogMAR respectively with ‘p’ value of 0.00001 which was significant. Mean astigmatism preoperative and postoperative was found to be 4.82±1.76D and 2.66±0.7D and ‘p’ value was significant (p=0.00042). Mean endothelial count preoperative and postoperative was 2479.18±239.42cells/cm2 and 2238.45±218.49cell/cm2 with percentage reduction of 9.6% at 1 year. Two eyes among them had postoperative double anterior chamber and two eyes had wrinkling of DM due to the advanced nature of KC. Conclusion: DALK can be successful in patients with pre-existing DM perforation if careful precautions are taken. Also layer by layer technique with a centripetal dissection is preferred in such cases to prevent intraoperative scar extension.