title: Impact of the descemet membrane perforation on surgical outcomes after deep lamellar keratoplasty.
abstract: OBJECTIVE
  To study the influence of the Descemet membrane (DM) perforations after deep lamellar keratoplasty (DLKP) on endothelial decompensation, endothelial density, visual acuity, and postoperative complications. The relationship between DM perforations and pseudoanterior chamber formation also was studied.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Ninety-six consecutive eyes of 89 patients who underwent DLKP with and without DM perforation were studied. The eyes with DM perforation were divided further into two groups: macroperforation and microperforation. Main outcome measures included graft survival, postoperative pseudochamber formation, endothelial density, and best spectacle-corrected visual acuity (BSCVA).
  
  
  RESULTS
  Overall, 88 of 96 eyes (91.7%) had clear grafts. Endothelial decompensation developed in three eyes (13.0%) in the eyes with perforation, which was significantly higher than in the eyes without perforation (1.4%; P = .047). Postoperative pseudochamber formation was observed in 60.0% in the perforated eyes, which was significantly higher than that observed in the imperforated eyes (19.7%; P = .0003). In the eyes with perforation, mean endothelial cell density was significantly decreased compared with that of the imperforated eyes at three and six months after surgery (P = .0497 and P = .0002, respectively). Three months after surgery, BSCVA in the imperforated eyes was significantly better than that in the perforated eyes (P = .016). Eyes with macroperforation were more likely to develop both pseudochamber and endothelial decompensation than eyes with microperforation.
  
  
  CONCLUSIONS
  Perforation of DM adversely affected endothelial decompensation and endothelial density after DLKP, especially in cases where perforations were large.
authors.affiliation: Department of Ophthalmology, Tokyo Dental College, Chiba, Japan. seikatdc@u01.gate01.com
authors.forename: Seika
authors.initials: S
authors.lastname: Den
authors.forename: Shigeto
authors.initials: S
authors.lastname: Shimmura
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tsubota
authors.forename: Jun
authors.initials: J
authors.lastname: Shimazaki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D002648:Child; D016039:Corneal Transplantation / Q000009:adverse effects*; D003886:Descemet Membrane / Q000293:injuries*; D004728:Endothelium, Corneal / Q000473:pathology*; D005260:Female; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012421:Rupture; D014792:Visual Acuity / Q000502:physiology