Amniotic Membrane Patch Graft in Management of Double Chamber after Deep Anterior Lamellar Keratoplasty

Abstract

Purpose: To describe a novel technique of amniotic membrane (AM) patch graft in the management of double chamber treatment after big-bubble deep anterior lamellar keratoplasty (DALK).


Case Report: A 35-year-old male patient with advanced keratoconus underwent bigbubble DALK. Manual lamellar dissection was done due to failed big-bubble. First-day postoperative double chamber was detected. Air bubbling and SF6 injection were tried without any success. Double chamber resolved by fixation of AM transplantation patch graft (1 × 1 mm) over the Descemet’s membrane perforation with fibrin glue.


Conclusion: Amniotic membrane patch graft can be used in the management of double chamber after DALK not responsive to intracameral gas injection.

Keywords:

Amniotic Membrane, DALK, Descemet Perforation, Double Chamber

References
1. Borderie VM, Sandali O, Bullet J, Gaujoux T, Touzeau O, Laroche L. Long-term results of deep anterior lamellar versus penetrating keratoplasty. Ophthalmology 2012;119:249–255.

2. Sugita J, Kondo J. Deep lamellar keratoplasty with complete removal of pathological stroma for vision improvement. Br J Ophthalmol 1997;81:184–188.

3. Passani A, Sframeli AT, Loiudice P, Nardi M. Late spontaneous resolution of a double anterior chamber post deep anterior lamellar keratoplasty. Saudi J Ophthalmol 2017;31:58–60.

4. Iradier MT, Moreno E, Aranguez C, Cuevas J, García Feijoo J, Garcia Sanchez J. Late spontaneous resolution of a massive detachment of Descemet’s membrane after phacoemulsification. J Cataract Refract Surg 2002;28:1071–1073.

5. Chow VW, Agarwal T, Vajpayee RB, Jhanji V. Update on diagnosis and management of Descemet’s membrane detachment. Curr Opin Ophthalmol 2013;24:356–361.

6. Assia EI, Levkovich-Verbin H, Blumenthal M. Management of Descemet’s membrane detachment. J Cataract Refract Surg 1995;21:714–717.

7. Kumar H, Ali MS, Mishra D. Management of Descemet’s membrane detachment by intra cameral air injection. Ann Int Med Den Res 2016;2:OT01–OT04.

8. Clare G, Suleman H, Bunce C, Dua H. Amniotic membrane transplantation for acute ocular burns. Cochrane Database Syst Rev 2012;9:CD009379.

9. Rahman I, Said DG, Maharajan VS, Dua HS. Amniotic membrane in ophthalmology: indication and limitations. Eye 2009;23:1954–1961.

10. Maurino V, Allan BD, Stevens JD, Tuft SJ. Fixed dilated pupil (Urrets-Zavalia syndrome) after air/gas injection after deep lamellar keratoplasty for keratoconus. Am J Ophthalmol 2002;133:266–268.

11. Anwar HM, El-Danasoury A, Hashem AN. The use of fibrin glue to seal Descemet membrane microperforations occurring during deep anterior lamellar keratoplasty. Cornea 2012;31:1193–1196.

12. Ghaffari R, Ghassemi H, Latifi G, Jabbarvand M, Zamzam A, Hashemi H. Stromal Patch with fibrin glue as a novel surgical technique to seal peripheral Descemet’s membrane perforations in deep anterior lamellar keratoplasty. Int Ophthalmol 2019;39:2275–2282.