Recipient Descemet Membrane Removal in Pseudo-Anterior Chamber After DALK With Retention of Donor Descemet Membrane
Narrative Responses:
Purpose
To describe the outcomes of 5 patients that had undergone deep anterior lamellar keratoplasty (DALK) with retention of donor Descemet membrane (DM) during donor cornea preparation and were treated with recipient DM removal after presenting with pseudoanterior chamber.
Methods
We retrospectively reviewed the records of keratoconus patients that had undergone DALK with retention of donor DM and that presented postoperatively with pseudoanterior chamber requiring surgical intervention from January 2012 to August 2013. Fourteen patients (14 eyes) were identified. Injection of air or nonexpansible C3F8 was performed in all cases. Five cases persisted after air/gas injection and underwent recipient DM removal. The following data were recorded for these 5 cases: DALK technique, time between DALK and pseudoanterior chamber, time between pseudoanterior chamber and DM removal, rate of graft failure and rate of graft rejection
Results
All 5 patients were female, mean age was 21 ±5.4 years. Deep lamellar dissection was performed using big bubble technique in 4 cases and manually in 1 case. Microperforation was noted intraoperatively in 4 cases. Mean time between DALK and pseudoanterior chamber presentation was 14 days (range 1 to 34 days). Three patients received C3F8 injection and 2 received air injection. Mean time between air/gas injection and DM removal was 18.2 days (range 5 to 37 days). There was no case of primary graft failure. Two patients presented graft rejection after DM removal with one of them developing secondary graft failure.
Conclusion
Persistent pseudoanterior chamber is a possible complication of DALK and can be successfully managed by early recipient DM removal if donor DM was left intact, avoiding a second graft. The retention of donor DM might be considered preemptively when an increased risk of pseudoanterior chamber is identified.