Deep Anterior Lamellar Keratoplasty for Keratoglobus: Managing Disparity of Curvature Between Donor and Recipient
Narrative Responses:
Purpose
To report how to manage the disparity of the curvature between donor and recipient during a pdDALK in keratoglobus, especially when Descemet’s rupture occurs.
Methods
Case report about pdDALK performed in both eyes of a patient with bilateral keratoglobus. In the right eye there were no complications. In the left eye Descemet’s rupture occurred. Stromectomy was completed. The remaining layer of the recipient bed (stroma-Descemet-endothelium) was cutted 360-degree full thickness and preserved. Donor graft was same size of the recipient and denuded of its endothelium. The cutted tissue from the recipient (Decemet-endothelium) was then sticked to the donor button using fibrin glue. Graft made by donor button and recipient’s endothelium was then sutured with 18 single interrupted sutures. Air bubble was left in anterior chamber.
Results
At the first day postop both grafts were clear, although few Descemet’s folds were visible in the right eye. After one week postop a detachment of recipient's endothelium was found in the left eye. A new air bubble into the anterior chamber was used to deal with this complication. No other donor-recipient adherence problems were recorded. After five months Descemet’s folds were no longer visible in the right eye. Cornea and ocular surface were stable until the last follow-up (21months).
Conclusion
DALK procedure for keratoglobus is possible. A full thickness 360° circular excision of the recipient bed seems to be a good approach to manage Descemet’s rupture in eyes with disparity of the curvature between donor and recipient.