Anterior Segment OCT Characterization of Double Anterior Chamber and Outcomes of Descemetopexy After Deep Anterior Lamellar Keratoplasty
To characterize the double anterior chamber after deep anterior lamellar keratoplasty (DALK) using anterior segment optical coherence tomography (ASOCT) and evaluate the efficacy of descemetopexy.
Retrospective case series of patients who underwent DALK for various indications with anterior corneal pathology and were identified to have double anterior chamber in the immediate post operative period on ASOCT between June 2008 to July 2014 were included. All the patients subsequently underwent descemetopexy with air or C3F8 gas injection. Success was defined as complete attachment of the Descemet’s membrane (DM) with restoration of corneal clarity and failure was defined as cases requiring a full thickness penetrating keratoplasty due to non-attachment of DM.
Twenty five eyes of 25 patients were included in the study. Big Bubble was achieved in 15 eyes (60%). Intraoperative DM perforation was noticed in 8 eyes (32%). On ASOCT, mean maximum vertical and horizontal detachments were 0.90±0.34mm (range 0.27 to 1.65) and 4.89±1.86mm (range 1.43 to 8.93) respectively. Anatomical success was achieved in 19 eyes (76%). Six eyes which failed had detachment in all the 4 quadrants. All the grafts which had successful attachment were clear at the last follow-up period. The primary indication, technique of DALK, maximum vertical and horizontal detachment did not influence the final outcome.
Double anterior chamber, a well known complication following DALK can be managed successfully by descemetopexy. Extent of DM detachment may not influence the outcome after descemetopexy. ASOCT can help in guiding the surgeon about the location and extent of detachment which enables safe performance of descemetopexy.