Impact of Intraoperative Descemet Membrane Perforation on Survival in Deep Anterior Lamellar Keratoplasty for Keratoconus.

PURPOSE

To investigate the influence of perforation of Descemet membrane (DM) on graft survival outcomes during deep anterior lamellar keratoplasty (DALK) for treating keratoconus.

METHODS

We retrospectively reviewed 81 eyes of 77 patients with keratoconus who underwent deep anterior lamellar keratoplasty (DALK). Graft survival, best spectacle-corrected visual acuity (BSCVA), corneal endothelial cell density, and postoperative complications were compared between eyes with and without intraoperative Descemet membrane (DM) perforations.

RESULTS

The overall rate of clear grafts was 91.4% 5 years after the operation. Intraoperative DM perforations occurred in 44% of the eyes. Graft survival at 5 years did not differ significantly between eyes with (86.1%) and without (95.6%) DM perforation ( P = 0.345). The incidence of double anterior chamber (DAC) was significantly higher in eyes with DM perforation (30.5%) than in eyes without DM perforation (11.1%) ( P = 0.048). Postoperative DAC was significantly associated with graft failure ( P = 0.013), and the 4 groups, with or without DM perforation and with or without DAC ( P = 0.035), differed significantly in graft failure. Visual acuity improved significantly after DALK in comparison with the preoperative BSCVA in eyes with and without DM perforation at all observation periods in both groups ( P < 0.0001). The BSCVA did not significantly differ between the 2 groups, except at 3 months after DALK ( P = 0.045).

CONCLUSIONS

Intraoperative DM perforation has no negative impact on the long-term prognosis of patients with advanced keratoconus.