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KMID : 1038920200190030072
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Annals of Optometry and Contact Lens
2020 Volume.19 No. 3 p.72 ~ p.77
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Deep Anterior Lamellar Keratoplasty Performed in the Rupture of Descemet’s Membrane during Corneal Stroma Dissection
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Lee Sang-Jae
Park Choul-Yong
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Abstract
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Purpose: To report a successful treatment of Descemet’s membrane detachment during deep anterior lamellar keratoplasty (DALK) through repeated air injections into the anterior chamber.
Case summary: A 57-year old woman underwent DALK for the treatment of central corneal opacity due to keratitis. After dissecting the recipient’s corneal stroma, Descemet’s membrane was detached through big bubble technique. Then, during the excision of residual corneal stroma with corneal scissors, a partial rupture of Descemet's membrane occurred. Because the rupture size was small (3 hours of meridian), DALK was continued. Air injection into the anterior chamber was performed to prevent detachment of the recipient’s descemet’s membrane. Next day, a localized folding of Descemet's membrane near the rupture area was observed with almost full air filling of the anterior chamber. Three days after the surgery, significant descemet’s membrane detachment with corneal edema developed and air filling of the anterior chamber was repeated. Thereafter, two additional anterior chamber air injections were repeated every three days. Finally, descemet’s membranes detachment was fully resolved with the restoration of corneal thickness and transparency.
Conclusions: Descemet’s membrane rupture during DALK and subsequent descemet’s membrane detachment can be successfully managed with repeated air injections into the anterior chamber as long as the size and location were favorable.
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KEYWORD
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Anterior chamber air injection, Corneal transplantation, Deep anterior lamellar keratoplasty, Descemet’s membrane detachment, Descemet’s membrane rupture
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