Novel Technique For The Management Of Macroperforation During Deep Anterior Lamellar Keratoplasty

PURPOSE: To describe the outcomes of a case series of patients who underwent a novel technique for managing macroperforation during deep anterior lamellar keratoplasty (DALK). METHODS: Nine eyes of 9 patients with advanced keratoconus who underwent DALK comprised the case series. A macroperforation occurred in all eyes during DALK. The stromal patch suturing technique was used to manage all cases; a large piece of the previously excised stromal tissue was sutured to the edge of the trephine to seal the perforation. The technical aspects of the procedure are described and data are presented on the visual outcomes, endothelial microscopy, and postoperative complications at last postoperative visit (average 18 months; range, 7 to 23 months). RESULTS: All 9 cases were managed successfully with the stromal patch suturing technique. Postoperatively, the graft was clear in all cases. At day 1, seven eyes had a Descemet’s membrane detachment, 3 of these eyes resolved spontaneously within 2 weeks and 4 required air bubble injection for successful reattachment. At last follow up seven eyes had a corrected distance visual acuity of 20/30 or better and 2 eyes had 20/40 vision. The average endothelial cell count was 2162 cell/mm(2). There were no cases with excessive inflammation or vascularisation during the postoperative follow-up. CONCLUSION: The stromal patch suturing technique was successfully used to manage intraoperative macroperforation during DALK. This technique resulted in endothelial changes that were consistent with uncomplicated DALK and function visual acuity of 20/40 or better in all cases with no postoperative sequelae.