Descemet’s Membrane Perforation During Deep Lamellar Keratoplasty:Management And Clinical Outcome

Purpose:To classify decement’s membrane (DM) perforation by morphology feature, and evaluate the outcomes of doubleanterior chamber(DAC), visual acuity, and corneal endothelialdensity change after deep lamellar keratoplasty (DLK).DESIGN:Retrospective studyMETHODS:Clinical notes of184eyes who underwent DLK between2011July and2013February. Intraoperative perforation occurred in25eyes. DM perforation was divided into three group, Needle-Tip type, Slit type and Open-Mouth type, according to their morphology feature. Main outcome evaluation including the influence of anterior chamber air injection on postoperative DAC formation, endothelial density, best correctedvisualacuity (BCVA),and other complication.RESULT:25of184(13.5%)eyes had DM perforation during DLK. The mean age of the patients was37.5±16.6years, and the male/female ratio was15:10. The Needle-Tip type DM perforation has10eyes(40%),the postoperative DAC persisted time with anterior chamber injection small volume air was7.33±0.28day, the mean endothelial cell loss was31.15%±22.41%. Preoperative BCVA wasLogMAR1.28±0.63, postoperative BCVA was logMAR0.51±0.56. The Slit type DM perforation has9eyes (36%), the postoperative DAC persisted time with anterior chamber injection medium volume air was14.5±2.08day, the mean endothelial cell loss was37.56%±15.01%. Preoperative BCVA wasLogMAR1.50±0.78, postoperative BSCVA was LogMAR0.54±0.47. The Open-Mouth type DM perforation has6eyes (24%), the postoperative DAC persisted time with anterior chamber injection medium volume air was34.6±12.58day, injection large volume air was13.3±4.16day. The mean endothelial cell loss was50.35%±16.66%. Preoperative BCVA wasLogMAR1.11±0.72, postoperative BCVAwas LogMAR0.96±0.70.Conclusions:The Needle-Tip type DM perforation often without any special treatment, postoperative double anterior chamber can be posted back spontaneously within one week, and this type perforation does not affect the operation proceeding. The Slit type DM perforation, anterior chamber air injection can reduce the duration of postoperative double anterior chamber. The Open-Mouth type DM perforation, it is necessary to inject air into anterior chamber to drain the collected aqueous humor from DAC, and forcing DM reattachment. However, the larger volume anterior chamber air injection can damage corneal endothelial cells and cause pupillary block glaucoma. Close monitoringis required when air isleft in the anterior chamber.