Modified Deep Anterior Lamellar Keratoplasty in the Management of Small and Large Epithelialized Descemetoceles

PURPOSE:Descemetocele is a severe complication of corneal ulceration associated with a high risk of perforation. We describe a modified air-assisted deep anterior lamellar keratoplasty (DALK) technique for the surgical management of small and large epithelialized descemetoceles. METHODS:Two representative cases are presented, one with a small (2 mm) and one with a large (4 mm) descemetocele. In both cases, the air-assisted lamellar dissection allowed a superficial keratectomy and access to the Descemet membrane. Viscoelastic was then directly injected through the stromal hole to separate the Descemet membrane from the posterior stroma, thereby allowing its complete removal. RESULTS:DALK was successfully performed using this modified air-assisted DALK technique. Visual acuity improved from counting fingers and hand motion to 20/40 and was maintained for at least 1 year after surgery. CONCLUSIONS:These cases demonstrate that the modified air-assisted DALK technique may be proposed for the management of small and large descemetoceles, allowing both tectonic and visual rehabilitation.