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PKP unnecessary for macroperforations from DALK, surgeon says

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ATHENS — Macroperforations as a complication of deep anterior lamellar keratoplasty can be easily handled without converting the procedure to penetrating keratoplasty, according to a surgeon speaking here.

"With the big bubble technique, which is safer, Descemet's [membrane] ruptures occur in about 4% of cases," Vincenzo Sarnicola, MD, said at Cornea Day during the ESCRS Winter Refractive Surgery Meeting. Conversion to PKP is easy, but no longer necessary, he added.

"I'm not converting anymore to PKP. I place the graft over Descemet's [membrane], suture it, fill the anterior chamber with air and remove the fluid between Descemet's [membrane] and the stroma," Dr. Sarnicola said. "If these maneuvers are performed correctly, the Descemet's membrane will reattach to the stroma also in cases you would never expect."

"If you are used to doing DALK, you do not want to do PKP because you know the postoperative course is completely different," he added.

Reducing the number of PKP procedures means "avoiding the risk of so many severe intraoperative complications and the high rejection rate that this procedure entails," Dr. Sarnicola said.