DLKP safe and effective to treat keratoconus, preserve endothelium

Lisbon, Portugal - Deep lamellar keratoplasty (DLKP) while exposing Descemet’s membrane seems safe and effective to correct keratoconus, according to Mohamed Alaa El-Danasoury, MD.

DLKP is an alternative to penetrating keratoplasty, which provides good visual acuity outcomes but has a major disadvantage of slow visual recovery and interface complications, he said.

Dr. El-Danasoury and colleagues from the Magrabi Eye Hospital, Jeddah, Saudi Arabia, reported on their results with this new procedure that was used to treat keratoconus in 50 patients. The patients underwent DLKP with injection of an air bubble in the pre-Descemet’s membrane plane. Injection of an air bubble facilitates lamellar dissection, Dr. El-Danasoury explained Sunday at the European Society of Cataract and Refractive Surgeons meeting.

“The air bubble is injected as deep as possible into the stroma. The goal is to push the air bubble between Descemet’s membrane and the deep stroma,” he said. “A paracentesis is created to relieve the pressure. The bubble is punctured to allow the air to escape. A spatula is inserted through the same plane and any stromal fibers can be cut with blunt scissors.”

The air-bubble technique was used in 39 patients (78%); manual dissection was necessary in the other 11 patients (22%). One year after the surgery, 46 eyes (92%) were re-examined. In 37 eyes (80%), the spectacle-corrected visual acuity was 20/40 or better. Complications included a fixed dilated pupil (0.5%), irregular astigmatism in five eyes (10%), and temporary detachment of Descemet’s membrane in seven eyes (14%)-six of which resolved spontaneously and one required air injection. There was no endothelial rejection in any cases, Dr. El-Danasoury reported.

“With DLKP there is no endothelial rejection, the procedure is safer in high-risk cases, and the endothelium is preserved,” Dr. El-Danasoury explained. “The disadvantages are that the procedure is time-consuming and cannot be performed when there are breaks in Descemet’s membrane.”