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Posterior disc replacement an option for eyes with post-DSAEK allograft rejection
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ATHENS — Posterior disc replacement is safe, easy and well tolerated in eyes with allograft rejection following Descemet stripping automated endothelial keratoplasty, according to a surgeon speaking here.
"Recovery is fast, and the cornea is perfectly clear within 1 week after the operation," Mohamed Alaa El Danasoury, MD, said at Cornea Day during the ESCRS Winter Refractive Surgery Meeting.
After his first case of graft rejection after Descemet stripping automated endothelial keratoplasty (DSAEK), Dr. El Danasoury was initially inclined to do PKP, but after discussing it with his patient, they finally agreed to try disc exchange, he said.
The donor disc was prepared in an artificial chamber with the Moria ALTK keratome and a Hanna trephine. Surgery was performed under local peribulbar anesthesia through a 4.5-mm incision, and the epithelium was removed for better visualization.
No viscoelastic was used, but an anterior chamber maintainer and balanced salt solution were used to maintain the anterior chamber throughout the procedure. The donor disc was folded with one drop of viscoelastic on the endothelial side and inserted through the incision, Dr. El Danasoury said.
"I let the disc unfold and guided its positioning on the back of the cornea using a reversed Sinskey hook," he said. "I removed the anterior chamber maintainer and secured the disc in place by injecting a large air bubble through a 30-gauge needle. No sutures were used to fix the disc."
The procedure lasted "no more than 20 minutes," Dr. El Danasoury said. The air bubble started to clear 1 day postop, and after 1 week the cornea was perfectly transparent, he said.
"I recommend this procedure in all cases of endothelial graft rejection. It preserves all the advantages of posterior lamellar keratoplasty, and PKP can be avoided," he said.