Intraoperative management of macroperforations of Descemet's membrane in deep anterior lamellar keratoplasty.
BACKGROUND
To describe a surgical approach for the completion of pre-descemetic deep anterior lamellar keratoplasty (pdDALK) in the presence of a macroperforation of Descemet's membrane (DM).


METHODS
Using case notes, we recorded the details of the intra- and perioperative course of patients who underwent successful pdDALK in the presence of macroperforation. A literature search of pdDALK techniques available to the corneal surgeon in a similar scenario was undertaken.


RESULTS
In two very different scenarios with intra- or preoperative perforation of DM, a centripetal layered lamellar dissection was performed and allowed completion of pdDALK with a residual recipient central stromal thickness of 36 and 115 µm and good visual outcome.


CONCLUSIONS
Despite very different scenarios, a centripetal layered lamellar dissection offers an approach for the completion of pdDALK in the presence of a macroperforation.
Department of Ophthalmology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
Bernhard
0000-0002-5316-4661
B
Steger
Department of Corneal and External Eye Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.
Vito
V
Romano
Department of Ophthalmology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
Christoph
C
Palme
Department of Eye and Vision Science, University of Liverpool, Liverpool, UK.
Stephen B
SB
Kaye
Corneal surgery; Descemet’s membrane perforation; Lamellar dissection; Pre-descemetic deep anterior lamellar keratoplasty; Surgical technique