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Preferred practice pattern and observed outcome of deep anterior lamellar keratoplasty - A survey of Indian corneal surgeons
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Preferred practice pattern and observed outcome of deep anterior lamellar keratoplasty - A survey of Indian corneal surgeons
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Journal Article
Preferred practice pattern and observed outcome of deep anterior lamellar keratoplasty - A survey of Indian corneal surgeons
2021
Overview
Purpose:
This study aimed to assess the preferred surgical technique and outcome of deep anterior lamellar keratoplasty (DALK) among corneal surgeons in India.
Methods:
An online questionnaire-based cross-sectional survey was conducted among members of the Cornea Society of India (CSI) with experience of performing >10 DALK procedure. The responses pertaining to their surgical experience, preferred technique, complications, and outcome of DALK were collected and analyzed.
Results:
A total of 156 responses were received. In total, 35.9% of participants reported annual keratoplasty of >50, and DALK constituted >25% surgeries for 25% of participants. Ectatic corneal disorder was reported as the most common indication for DALK by 71.6% of the respondents. Big-bubble (BB) DALK (WA-1.82) was the most preferred technique, along with suction trephine (50%) for partial trephination and bottom port cannula (45.5%) for BB formation. On statistical analysis, no difference was observed in the surgeon reported success rate of BB formation with or without anterior lamellar keratectomy (ALK) (Χ2 (1,156) = 3.1498, P = 0.08) or paracentesis (Χ2 (1,156) = 0.2737, P = 0.60) before stromal air injection, and method of stromal air injection (Χ2 (1,156) = 4.7325, P = 0.09). Conversion to penetrating keratoplasty was reported by 16% of participants in >25% cases, while 66.7% reported in <10% cases. Cataract and double anterior chamber were the most common complications. 50% of participants suggested that >20 procedures are required to overcome the learning curve.
Conclusion:
BB DALK is the most commonly practiced DALK technique, and its success is independent of ALK and paracentesis being performed prior to air injection and method of air injection (cannula/needle).
Publisher
Wolters Kluwer - Medknow,Medknow Publications and Media Pvt. Ltd,Medknow Publications & Media Pvt. Ltd,Wolters Kluwer Medknow Publications
