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Anwar technique most effective in exposing Descemet's membrane in DALK cases

Cornea. 2010;29(1):53-9.

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A retrospective analysis of deep anterior lamellar keratoplasty with the Tsubota, Sugita, Melles or Anwar techniques found that the Anwar technique exposed Descemet's membrane most often.

"Performing DALK, we had the greatest likelihood of reaching Descemet's membrane with the Anwar big bubble technique," the study authors said. "The visual outcomes are comparable to standard PK, avoiding the risk of endothelial rejection. Endothelial cell loss was low and the cell count was stable after 6 months."

Of the 236 eyes of 198 keratoconus patients that underwent DALK in the study, 139 were classified as "dDALK," or eyes that had true Descemet membrane exposure.

In addition to dDALK, authors also identified 94 "pdDALK" eyes "in which a predescemetic plane was achieved."

The Anwar technique had the highest incidence of exposure of Descemet's membrane, at 77% of cases.

"There was no difference in visual acuity between the pdDALK and dDALK groups at an average follow-up of 30.4 months, although the eyes in the dDALK group seemed to have faster visual recovery," the authors said.

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