title: Descemet's membrane perforation during deep anterior lamellar keratoplasty: prognosis.
abstract: OBJECTIVE
  To evaluate the functional and endothelial prognosis after Descemet's membrane perforation during deep anterior lamellar keratoplasty (DALK).
  
  
  METHODS
  Private practice, Siena, Italy.
  
  
  METHODS
  A retrospective study evaluated a series of 35 eyes that had DALK using the big-bubble technique.
  
  
  RESULTS
  Intraoperative perforation occurred in 8 eyes (23%), in 5 eyes during manual deep dissection and in 1 eye each during trephination, as the air needle was introduced in the stroma, and as the big bubble was punctured. In all 8 eyes, DALK could be completed. In 1 case, pupillary block was caused by air left in the anterior chamber, resulting in permanent mydriasis and anterior subcapsular opacity. In another case, a double anterior chamber persisted and penetrating keratoplasty was later required. In the other 6 cases, the postoperative course was uneventful. The mean postoperative best spectacle-corrected visual acuity was 0.8 +/- 0.13 (SD) and the mean postoperative refractive astigmatism, 2.09 +/- 0.98 diopters. The mean endothelial cell loss, evaluated in 7 eyes, was 12% +/- 11% at 1 month (P<.05) and 14% +/- 12% at 12 months. The mean cell loss was 25% +/- 2.7% in eyes in which intraoperative reformation of the anterior chamber with air was required and 6% +/- 7.5% in eyes in which it was not (P< .05).
  
  
  CONCLUSIONS
  Despite 2 complicated cases, intraoperative perforation during DALK had a good final functional prognosis. However, eyes in which the perforation required reformation of the anterior chamber had a mean endothelial cell loss greater than 20%. When air is left in the anterior chamber, close monitoring is required to avoid pupillary block.
authors.affiliation: Ophthalmic Surgery Unit, Casa di Cura Rugani, Siena, Italy. leccisotti@libero.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Leccisotti
mesh_terms: D000328:Adult; D002452:Cell Count; D003316:Corneal Diseases / Q000209:etiology; D016039:Corneal Transplantation / Q000009:adverse effects*; D003886:Descemet Membrane / Q000293:injuries*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012421:Rupture; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology