Saturday, September 13, 2008

DLKP with bubble technique safe and effective to treat keratoconus


Deep lamellar keratoplasty (DLKP) using the injection of an air bubble appears to be a safe and effective procedure to correct keratoconus, Mohamed Alaa El-Danasoury MD told attendees at the XXVI Congress of the ESCRS.

“There is no endothelial rejection with DLKP, the procedure is safer in high-risk cases, it is reproducible and it enables a planned and controlled baring of Descemet’s membrane. Other benefits include the fact that there is no host-donor stromal interface, hence no endothelial rejection, it does not require excellent donor tissue and the refractive outcome can also be improved at a later date if required,” he said.

Disadvantages of the procedure include the learning curve needed to master the techniques involved and the fact that it cannot be performed when there are breaks in Descemet’s membrane, he added.

Dr El-Danasoury and colleagues at the Magrabi Eye Hospital, Jeddah, Saudi Arabia, reported on their results using the big bubble procedure to treat keratoconus in 87 patients.

He noted that the prevalence of the disease appears to be on the rise in his region.

“In the Middle East and Saudi Arabia, the prevalence of keratoconus is very high compared to countries in the west. We are seeing an average of four to five new cases every day and it is the foremost indication for corneal transplantation in our region,” he said.

In terms of patient selection for DLKP, Dr El-Danasoury stressed the importance of acting promptly to avoid the need for penetrating keratoplasty at a later stage.

“We do not let the patient wait until he is no longer a good candidate for lamellar keratoplasty. Our main concern is that we do not want the disease to progress to the point where the patient needs a full thickness graft. There is a very big difference between doing a lamellar graft versus a penetrating graft in these young patients with keratoconus because we are effectively nullifying the risk of having an endothelial graft rejection for the rest of their life,” he said.

The air-bubble technique was used in 113 eyes of 87 patients. All of them had moderate or advanced keratoconus and were dissatisfied with their corrected vision and/or hard contact lens wear, and all of them had intact Descemet’s membrane.

“We achieved Descemet’s separation using the big bubble technique in 91 per cent of the cases, with micro-perforations in seven per cent and we did not have to convert to a penetrating keratoplasty in any of the patients,” he said.

One year after the surgery, 84 per cent of patients recorded an uncorrected visual acuity of 20/40 or better, and 80 per cent were 20/40 or better three months after removing the sutures, concluded Dr El-Danasoury.

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