2020–2021 BCSC Basic and Clinical Science Course™
8 External Disease and Cornea
Chapter 15: Clinical Approach to Corneal Transplantation
Complications associated with lamellar keratoplasty
Opacification and vascularization of the interface
Meticulous dissection of the lamellar plane during both ALK and DALK is essential to creation of a smooth, clear interface. Irrigation and cleaning of the lamellar bed at the time of surgery reduces the likelihood of postoperative opacification. Retained interface debris, secondary vascularization, microbial infections, or wrinkling of the Descemet membrane can reduce vision or prolong vision rehabilitation. Neovascularization can increase the risk of lipid keratopathy, leading to further corneal opacification.
Because the corneal endothelium is not transplanted, endothelial rejection cannot take place. Epithelial rejection, subepithelial infiltrates, and stromal rejection can still occur, but they usually respond to corticosteroid therapy. Stromal rejection, characterized by significant haze and deep vascularization, can lead to corneal opacification and is more common after DALK than PK (Fig 15-14).
Complications unique to deep anterior lamellar keratoplasty
Rupture of the Descemet membrane
If there is a small rupture, the procedure may still be completed but may result in a Descemet detachment (see the following discussion). If there is a large perforation, conversion to PK may be necessary.
Double anterior chamber or Descemet detachment
Descemet detachment or double (pseudo) anterior chambers can occur because of fluid in the interface, which results from a host perforation or retained viscoelastic material. Injection of air into the anterior chamber can help with reattachment; however, it may also reduce the endothelial cell count and lead to the development of an anterior subcapsular cataract.
Figure 15-14 Stromal haze (A) and deep vascularization (B) following deep anterior lamellar keratoplasty.
(Courtesy of Robert W. Weisenthal, MD.)
Postoperative complications common to lamellar and penetrating keratoplasty
Complications common to lamellar and penetrating keratoplasty include prolonged healing due to ocular surface disease, suture erosion and abscess, infectious keratitis, neovascularization, graft rejection, and graft failure.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.