The following is a summary of “DALK combined interlamellar tectonic patch graft: an alternative approach to treat frank corneal perforation,” published in the October 2023 issue of Ophthalmology by Xiao et al.

Deep anterior lamellar keratoplasty (DALK) is popular for thinning corneas and leaking descemetoceles. Researchers performed a retrospective study to evaluate the efficacy of an intralamellar tectonic patch graft in DALK for frank corneal perforation. 

In this retrospective case series spanning from December 2015 to December 2021, 13 patients (13 eyes) with frank corneal perforations underwent a procedure known as DALK. This procedure involved the standard DALK method, and the perforation site was mended using an intralamellar tectonic patch graft. The data collected encompassed patient demographics, the causes of the condition, the size and location of the corneal perforation, visual acuity, surgical particulars, and any postoperative complications. 

About 7 patients received autologous intralamellar patch grafts, while six received allogeneic grafts. Anatomical success was achieved in all patients. The mean postoperative follow-up period was 33.31 ± 25.96 months (6 to 73 months). Postoperatively, visual acuity significantly improved (0.90 ± 0.65 logMAR) compared to preoperative scores (1.74 ± 0.83 logMAR) (P = 0.003). Best corrected visual acuity (BCVA) improved in 92.3% of eyes. The mean endothelial cell density was 2028 ± 463 cells/mm² at 6–12 months postoperatively. There were no instances of perforation recurrence, and the anterior lamellar graft remained transparent in 92.3% of patients. Postoperative complications included epithelial defects (23.1%), ocular hypertension (15.4%), and cataracts (7.7%).

The study found that DALK with intralamellar patch graft is a safe and effective alternative to conventional penetrating keratoplasty for frank corneal perforation, with fewer complications.

Source: bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-023-03179-7