AIM: To compare clinical and tomographic outcomes of patients with intraoperative descement membrane (DM) perforation during deep anterior lamellar keratoplasty (DALK) versus straightforward DALK surgery.
METHODS: This was a retrospective comparative study of 49 keratoconic patients who underwent DALK. They were subdivided into group I, which included patients with intraoperative DM perforation (n=13), and group II, included patients without perforation (n=36). Best Corrected visual acuity (BCVA), corneal tomographic parameters, and endothelial cell counts were recorded 12 months postoperatively.
RESULTS: Intraoperative DM perforation occurred in 13 (26.5%) eyes. BCVA became nearly similar in both groups at 12th month (0.30 ± 0.12 vs 0.31 ± 0.13, p=0.816). The mean Endothelial cell density (ECD) at 12 months postoperatively was 1732.62 ± 539.52 in group I compared to 2215.94 ± 265.62 cell/mm2 in group II (P<0.001*). The mean value of the logarithm of contrast sensitivity (CS) was 0.77 ± 0.235 in group I compared to 1.04 ± 0.187 in group II (P<0.001*). In group I, intracameral air injection correlated with a decrease in postoperative CS and ECD (P=0.001 and 0.004, respectively).
CONCLUSIONS: DM perforation is a common complication of DALK surgery. Intracameral air injection is correlated with a decrease in ECD and quality of vision.