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Deep anterior lamellar keratoplasty (DALK) in Tohoku University, Japan

Deep anterior lamellar keratoplasty (DALK) in Tohoku University, Japan. T Hariya MD, A Kubota MD PhD, M Uematsu MD, S Yokokura MD PhD,K Nishida MD PhD, Tohoku University of Medichine , Japan. The authors have no financial interest in the subject matter of this poster. PURPOSE.

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Deep anterior lamellar keratoplasty (DALK) in Tohoku University, Japan

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  1. Deep anterior lamellar keratoplasty (DALK) in Tohoku University, Japan T Hariya MD, A Kubota MD PhD, M Uematsu MD, S Yokokura MD PhD,K Nishida MD PhD, Tohoku University of Medichine, Japan The authors have no financial interest in the subject matter of this poster.

  2. PURPOSE Facilities where deep anterior lamellar keratoplasty (DALK) is done are fewbecause of the difficulty of the technique and the high rate of descemet’s membrane rupture. To analyze visual acuity, endothelial cell dencity, graft survival and complications of 40 eyes undergone DALK in Tohoku University, Japan

  3. METHOD STUDY DESIGN: Retrospective study from March, 2006 to August, 2009.All cases were operated by cornea specialists, and observed continuously after the operation for three months or more. Five cases were excluded because of dropout. NUMBER：39cases 40eyes OBSERVATION PERIOD:8.1±9.9(3-37)months MAN:FEMALE:20:19 cases AGE:57.0±19.3 years old SIMULTANEOUS SURGERY:PEA+IOL (5eyes), limbal transplantation (2eyes) ADDITIONAL SURGERY:PEA+IOL(3eyes),YAG laser(1eye)

  4. PRIMARY DESEASES coneal opacity after infection ・interstitial keratitis, 8 ・herpes, 5 ・trachoma, 2 ・acantoamoeba, 1 ・unknown , 1 others ・corneal opacity postoperative pterygium, 1 ・macular dystorophy, 1 ・corneal perforation after infection （Candida）, 1 ・corneal perforation (rheumatism), 1

  5. TECHNIQUE OF DALK #1 mirror imaging technique #2 Visco-dissectiontechnique #3Big bubble technique #4Small bubble technique #5Double bubble technique #6limbal approach #7Hydrodelaminationtechnique #8Hookingtechnique Hooking technique In Tohoku university We performed DALK with #7 until 2007., and with #8 from 2008.

  6. Case 62 years old MAN lattice corneal dystorophy type Ⅰ ⇒ Preoperative visual acuity logMAR 1.5 Postoperative visual acuity logMAR 0.3 1 year later

  7. GRAFT SURVIVAL 35/40 eyes88% In 5 eyes, corneal graft were failed because of following causes. 　　①corneal opacity after infection(unknown) 　　→graft infection (Candida) 　　②corneal perforation due to rhematism 　　　→endothelial decompentation 　　③trachoma 　　　→graft infection (Candida) 　　④corneal opacity after interstitial keratitis 　　　→rejection 　　⑤keratoconus 　　　→rejection

  8. COMPLICATIONS ◆Descemet rupture rate12/51 eyes 24% 　⇒11eyes converted to PKP(penetrating keratoplasty) 　～2007hydrodelamination technique23% 2008～　hookingtechnique17% Descemet rupture rate of operation with hooking technique is lower than that with hydrodelamination. 1) ◆Elevation of intraocular pressure(IOP) 9/40 eyes23% In all cases, elevation of IOP was temporary or normalized in eye-drop treatment. ◆Double chamber5/40 eyes13% Injected SF6 gas into anterior chamber. (1 eye) 1) M.tsuchiyamaet.al. tohoku university: Japanese society of ophthalmic surgeons

  9. 1M 3M 6M 12M 24M RESULT 0 1 2 3 Final visual acuity improvement conservation reduction 3 2 1 0 Preoperation visual acuity FIGURE2: Preoperatin Visual acuity vs. final visual acuity in logMAR. It was improved in most cases. FIGURE1:logMAR Visual acuity improved by two or more. ※counting finger=2.4hand motion=2.7light perception=3

  10. RESULT ※ ※ n=12 n=20 n=13 FIGURE3: The progression of endothelial cell density(ECD) . The rate of ECD decrease was 24% at 6 month, 26% at 12month. n=22 n=20 ↑ 1M 3M 6M 12M Pre-operation ※ p<0.05

  11. CONSIDERATION Descemet rupture rate24% Descemet rupture rate fell by selecting the technique. According to the other report, it was 39.2%1),18.2％2),23%3),23%4),11.6%5). There was no significant deference. Double chamber13% It can get well naturally. And it is effective to inject SF6 gas into anterior chamber. Visual acuity It was improved in most cases. Endothelial cell dencity (ECD) It was decreasing. There was no significant deference comparing to other reports. 1)Sugita et al:Br.J.Opthalmol.1997、2) Shimazaki et al:Am.J.Opthalmol.2002 3)Senoo et al:Br.J.Opthalmol.2005 、4)Leccisotti et al:J Cataract Refract Surg.2002 5)Yu-HengYao:Cornea,September 2008

  12. CONCLUSION DALK has a few complications, and can be considered effective treatment for corneal opacity without endothelial damage.

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