Evaluation of endothelial cell loss after deep anterior lamellar keratoplasty / Mahmoud Sami Mahmoud ; Supervised Khaled Abouelenin , Nehal Maher Elgendy , Rasha Moussa

Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Ophthalmology

DALK is now a standard procedure for corneal stromal diseases (Amayem et al, 2013). The ability to preserve a healthy endothelium and operating on a closed globe are significant advantages of DALK over PKP (Anwar et al, 2002). The loss of endothelial cells occurs immediately after DALK and remains almost constant thereafter. van Dooren BT et al observed a rate of endothelial cell loss of 14.3% over a 2- year period after DALK with the Melles{u2019} technique (van Dooren et al, 2004). The majority of cell attrition occurred within the first 6 months post-operatively (11.1%), reaching a physiologic rate of 1-2% per year thereafter. In comparison, a rate of 33% has been reported over the same time period after PK. (Shimazaki et al, 2002). Endothelial cell loss after DALK is chiefly attributed to surgical trauma and, in the early post-operative period, it does stabilize. (Bourne, 2001). In contrast, cell loss after PK may result from the surgical trauma, endothelial cell redistribution and episodes of allograft rejection (Bourne, 2001) In Our Study we adopted Anwar big-bubble technique, where air is injected into the deep stroma with the aim of inducing separation by cleavage between posterior stroma and the DM, allowing the surgeon to gain a safe and direct access to this plane, with the advantages of shortening the surgical time reducing the risk of perforation and exposing a smooth even surface of excellent optical quality. In our Study we have found that DALK appears to be an acceptable & more effective alternative to PK in Keratoconus & stromal corneal diseases, being safer in terms of endothelial cell density and diminished rejection rate across the recognised time period of 6 weeks and 24 weeks for 30 Patients. However, Significant Endothelial Cell loss was found during early post-operative follow up period of 18.3 % in 6 weeks and 34.8 % in 24 weeks

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