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Modified Ferrara’s technique for deep anterior lamellar keratoplasty (DALK)

Modified Ferrara’s technique for deep anterior lamellar keratoplasty (DALK). Sérgio Kwitko , Melissa M. Dal Pizzol, Diane Marinho, Samuel Rymer Hospital de Clínicas de Porto Alegre Federal University of Rio Grande do Sul - Porto Alegre - Brazil

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Modified Ferrara’s technique for deep anterior lamellar keratoplasty (DALK)

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  1. Modified Ferrara’s technique for deep anterior lamellar keratoplasty (DALK) Sérgio Kwitko, Melissa M. Dal Pizzol, Diane Marinho, Samuel Rymer Hospital de Clínicas de Porto AlegreFederal University of Rio Grande do Sul - Porto Alegre - Brazil The authors have no financial interest in the subject matter of this poster

  2. Modified Ferrara’s technique for DALK Intraoperative corneal dissection with nylon 6.0 (A) and final result (B) A more recently described technique by Ferrara1 uses a wider channeling ring similar to that used for implantation of intracorneal ring segments. The curved dissection spatula has an eyelet at its tip through witch a 6.0 mononylon suture is passed. An 8.0 mm optical zone is marked on the cornea, and a 1.0 mm radial incision is performed with a micrometer diamond knife set to 90% of local corneal thickness. The curved dissection spatula is rotated into the cornea stroma 360° until the tip reaches the radial incision. The two ends of the 6.0 mononylon suture are pulled, performing a dissection through the corneal stroma (Fig. A). Trephination of the recipient cornea is performed with a Hessburg-Barron vaccum trephine, and the full thickness donor cornea is suture in place. The authors describe the results of a modified Ferrara technique which is based on the same technique described above except that a manual dissection is performed when residual stroma was not smooth or thin enough. • Purpose: To evaluate the results and complications of modified Ferrara technique for deep anterior lamellar keratoplasty (DALK). A B 1. Ferrara P. Ferrara's Technique for Lamellar Keratoplasty: Easy and Safe. April 27-May 2, 2007; ASCRS Film Festival Winners 2007

  3. Modified Ferrara’s technique for DALK • Methods: Retrospective study of 73 eyes that underwent DALK with the modified Ferrara technique. Underlying corneal diseases were keratoconus in 63 eyes, leukoma in 6 eyes, and post-Lasik ectasia in 4 eyes. Preoperative best corrected spectacle visual acuity (BCSVA) was 20/40 or better in 5.1%, between 20/50 and 20/80 in 23.7%, and 20/100 or worse in 71.2%. Postoperative follow-up period was 13.1 ± 6.2 months.

  4. Modified Ferrara’s technique for DALK Table 1. Intraoperative and postoperative complications • Results: Twelve eyes (16.4%) had Descemet´s membrane perforation during surgery, with conversion to penetrating keratoplasty in two eyes (2.7 %). The other ten eyes sealed with fibrin glue. One eye (1.4%) developed Staphilococcus keratitis, requiring a therapeutic penetrating keratoplasty. Four eyes (5.5%) developed stromal rejection successfully treated with topical 1% prednisolone (Table 1). Postoperative BCSVA was 20/40 or better in 79.7% of the eyes, between 20/50 and 20/80 in 16.9%, and worse than 20/100 in 3.4% (Table 2). There was no significant difference between the dependent variables (postoperative BCVA, intra and postoperative complications) and the independent variables (preoperative BCVA, sex, age, central pachimetry, donor/recipient diameter differences, and depth of radial incision). Table 2. Postoperative BCSVA Total = 73 Percentage of patients (%) BCSVA

  5. Modified Ferrara’s technique for DALK • Conclusion: Modified Ferrara technique seems to be a good option to achieve DALK, with good visual outcomes, and complication rates similar to other DALK techniques.

  6. Modified Ferrara’s technique for DALK • References: • Anwar M, Teichmann KD. Big-bubble technique to bare Descemet's membrane in anterior lamellar keratoplasty. J Cataract Refract Surg 28:398-403, 2002. • Ardjomand N; Hau S; McAlister JC et al. Quality of vision and graft thickness in deep anterior lamellar and penetrating corneal allografts. Am J Ophthalmol 143:228-235, 2007. • Ferrara P. Ferrara's Technique for Lamellar Keratoplasty: Easy and Safe. 2007 ASCRS Meeting. ASCRS Film Festival Winners 2007. • Fontana L; Parente G; Tassinari G. Clinical outcomes after deep anterior lamellar keratoplasty using the big-bubble technique in patients with keratoconus. Am J Ophthalmol 143:117-124, 2007. • Leccisotti A. Descemet's membrane perforation during deep anterior lamellar keratoplasty: prognosis. J Cataract Refract Surg 33:825-9, 2007. • Parthasarathy A; Por YM; Tan DT. of Anwar's "big-bubble technique" for deep lamellar keratoplasty with complete baring of Descemet's membrane. Br J Ophthalmol 91(10):1369-73, 2007. • Vajpayee RB; Tyagi J; Sharma N et al. Deep anterior lamellar keratoplasty by big-bubble technique for treatment corneal stromal opacities. Am J Ophthalmol 143:954-957, 2007.

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