Stromal Patch with fibrin glue as a novel surgical technique to seal peripheral Descemet's membrane perforations in deep anterior lamellar keratoplasty.

Abstract:

PURPOSE:The purpose of this article was to introduce a novel surgical technique for the management of peripheral Descemet's membrane perforation during deep anterior lamellar keratoplasty (DALK). METHODS:First, a thin stromal patch was prepared either from the anterior stromal lamella cut during DALK or from the anterior stroma of a Descemet's stripping automated endothelial keratoplasty button. The stromal patch was secured in a stromal pocket dissected deep in the trephination edge along the perforation site. Fibrin glue was applied to the stromal patch. Finally, the graft was sutured to the recipient bed. RESULTS:We used this technique in 3 cases with peripheral DM perforations during DALK. The first case was a persistent postoperative double anterior chamber who developed Urrets-Zavalia syndrome after air injection in an attempt to seal the perforation. In the second case, this technique was applied to seal an intraoperative DM perforation, without which the procedure would have been converted to penetrating keratoplasty. The third case had a persistent postoperative double chamber despite multiple air injections and fibrin glue application. The technique was effective in the management of all DM perforations with a resolution of double anterior chamber. CONCLUSION:This technique is safe and effective as an intraoperative method or a postoperative measure to seal peripheral DM perforations. We recommend this technique for repairing peripherally located DM perforations during DALK not amenable to simple measures like air injection or fibrin glue application.

journal_name

Int Ophthalmol

authors

Ghaffari R,Ghassemi H,Latifi G,Jabbarvand M,Zamzam A,Hashemi H

doi

10.1007/s10792-018-01065-6

subject

Has Abstract

pub_date

2019-10-01 00:00:00

pages

2275-2282

issue

10

eissn

0165-5701

issn

1573-2630

pii

10.1007/s10792-018-01065-6

journal_volume

39

pub_type

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