In the manuscript titled “Management of Descemet's Membrane Folds after Deep Anterior Lamellar Keratoplasty: Descemet Membrane—Tucking Technique,” we described a simple technique to displace the graft periphery Descemet membrane (DM) folds when present at the end of the procedure. We agree with Nagpal et al that the occurrence of this complication is relatively rare and more frequently seen in cases of keratoconus with severe corneal ectasia (central mean Ks ≥ 60 D). DM folds may occur after big-bubble Deep Anterior Lamellar Keratoplasty (DALK) regardless of the type of bubble achieved (type 1 or 2), and they typically present as fine folds with linear or curvilinear circumferential orientation (Fig. 1). As correctly mentioned by the authors of this letter, DM folds may be the cause of visual disturbances for the patients particularly at night while driving. We have observed that DM folds, when present, should be corrected as soon as seen in the postoperative period, whenever they involve the central 4-mm visual axis. Surgical correction using the technique we suggested should take place within 1 month after surgery because after 1 month, the DM folds tend to remain despite efforts to correct them. Among the 16 cases reported, none of the patients developed recurrence of folds in the central visual axis after 6 months of follow-up or more. As we mentioned in the study, after the DM–tucking technique, DM folds in the peripheral graft–host interface often remain visible, but they do not cause visual disturbances. The DM–tucking technique should be carried out using a blunt tip spatula by gently pressing on the host membrane. In the case of type 1 bubble formation, this membrane is fairly resistant and the risk of membrane tearing is low because it never occurred in the patients reported. We mentioned that in the case of bubble 2 formation, the risk of tearing is greater and the maneuver should be conducted with great caution. However, should a DM tear occur, this should remain in the periphery and fairly easily managed by injecting an air bubble in the anterior chamber in case of double anterior chamber formation
Reply / Fontana L; Neri A; Moramarco A. - In: CORNEA. - ISSN 0277-3740. - STAMPA. - 38:9(2019), pp. E41-E42.
Reply
Fontana L;
2019
Abstract
In the manuscript titled “Management of Descemet's Membrane Folds after Deep Anterior Lamellar Keratoplasty: Descemet Membrane—Tucking Technique,” we described a simple technique to displace the graft periphery Descemet membrane (DM) folds when present at the end of the procedure. We agree with Nagpal et al that the occurrence of this complication is relatively rare and more frequently seen in cases of keratoconus with severe corneal ectasia (central mean Ks ≥ 60 D). DM folds may occur after big-bubble Deep Anterior Lamellar Keratoplasty (DALK) regardless of the type of bubble achieved (type 1 or 2), and they typically present as fine folds with linear or curvilinear circumferential orientation (Fig. 1). As correctly mentioned by the authors of this letter, DM folds may be the cause of visual disturbances for the patients particularly at night while driving. We have observed that DM folds, when present, should be corrected as soon as seen in the postoperative period, whenever they involve the central 4-mm visual axis. Surgical correction using the technique we suggested should take place within 1 month after surgery because after 1 month, the DM folds tend to remain despite efforts to correct them. Among the 16 cases reported, none of the patients developed recurrence of folds in the central visual axis after 6 months of follow-up or more. As we mentioned in the study, after the DM–tucking technique, DM folds in the peripheral graft–host interface often remain visible, but they do not cause visual disturbances. The DM–tucking technique should be carried out using a blunt tip spatula by gently pressing on the host membrane. In the case of type 1 bubble formation, this membrane is fairly resistant and the risk of membrane tearing is low because it never occurred in the patients reported. We mentioned that in the case of bubble 2 formation, the risk of tearing is greater and the maneuver should be conducted with great caution. However, should a DM tear occur, this should remain in the periphery and fairly easily managed by injecting an air bubble in the anterior chamber in case of double anterior chamber formationI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
