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Descemet’s membrane exposure rates in DALK vary by corneal pathology
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Rates of Descemet’s membrane exposure in deep anterior lamellar keratoplasty performed with the big-bubble technique varied according to indications for surgery, a study found.
“To our knowledge, this is the first study to investigate the success rate of the big-bubble technique in the treatment of various ocular pathologies,” the study authors said.
The prospective study included 131 eyes of 115 patients who underwent DALK for various indications; mean patient age was 33.6 years.
DALK with the big-bubble technique was performed in 86 eyes, and 45 eyes underwent DALK with manual stromal dissection because air injection failed to form a big bubble.
Primary indications for surgery were advanced and moderate keratoconus, stromal scars resulting from herpes simplex keratitis, stromal scars resulting from bacterial keratitis, corneal dystrophy, and corneal opacity resulting from chemical or thermal burn.
Study results showed that Descemet’s membrane was exposed successfully in 80.6% of eyes with advanced keratoconus, 73.3% of eyes with chemical or thermal burns, 71.4% of eyes with corneal dystrophy, 70% of eyes with herpes simplex keratitis scar, 36.4% of eyes with moderate keratoconus and 31.3% of eyes with bacterial keratitis scars. The difference in exposure rates between eyes with advanced keratoconus and those with moderate keratoconus and bacterial keratitis scars was statistically significant (P < .05).
Data showed no statistical variation in best corrected visual acuity between various diagnoses at mean follow-up of 21.4 months, at least 6 months after suture removal. In eyes with sutures still in place at 1 year, BCVA was significantly higher in those with herpes simplex keratitis scar and corneal dystrophy than in those with advanced or moderate keratoconus or corneal burn (P < .05).
Perspective
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Marianne O. Price, PhD
This study provides a classic example of how new treatments with improved benefit-to-risk ratios result in wider utilization, allowing more patients to benefit. Beginning in 2007, patients diagnosed with corneal endothelial disease were increasingly likely to be treated with a cornea transplant in this study of managed care beneficiary data. This coincided with a period of exponential growth in use of small-incision endothelial keratoplasty (EK), which is safer and provides faster visual recovery than traditional penetrating keratoplasty. It is reassuring that the number of adverse events after keratoplasty remained low during this transition period. However, the rate of serious adverse events with EK vs. PK could not be directly determined in this study. The introduction of a unique billing code for EK in 2009 should facilitate future analyses.
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Am J Ophthalmol. 2012;154(2):282-289.
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