Tectonic Deep Anterior Lamellar Keratoplasty to Treat Corneal Perforation and Descemetocele from Microbial Keratitis

Figures & data

Table 1 VNEH Subjective Grading Scheme

Grade Clarity	Characteristics
Clear graft	Observable iris details
Mild opaque graft	Good view of pupil edges and no view of iris details
Severe opaque graft	No view of pupil edges

Table 2 Pathogens and Preoperative Time

Causes	Number of Patients (%)	Mean Pre-Operative Course (Day)
Herpes Simplex Virus	21 (58.3)	70.6
Bacteria	8 (22.2)	37.0
Fungi	5 (13.9)	105.4
Microsporidia	2 (5.6)	270

Table 3 Pre- and Post-Operative Visual Acuity

Patient	Age (Yrs.)	Gender	Pathogen	Time After the Onset (Days)	Defect Location	Graft Diameter	Pre-Op VA	Post-Op VA
1	67	Female	HSV	65	Central	7.5	HM	CF at 2m
2	35	Male	HSV	56	Central	7.5	HM	20/200
3	51	Male	HSV	90	Central	7.5	HM	CF at 2m
4	59	Male	Fungi	90	Paracentral	5.5	HM	CF at 1m
5	43	Male	Fungi	210	Peripheral	5.5	20/400	20/160
6	25	Male	HSV	30	Central	7.0	HM	20/200
7	57	Female	Fungi	90	Central	7.5	HM	CF at 1m
8	29	Male	Bacteria	18	Central	7.5	HM	CF at 2m
9	74	Female	Microsporidia	180	Central	7.0	CF at 0.6m	Failed
10	66	Male	HSV	65	Paracentral	3.0	CF at 2m	CF at 2m
11	54	Female	Bacteria	25	Peripheral	3.0	20/160	20/70
12	40	Male	Bacteria	20	Peripheral	3.0	20/100	20/60
13	51	Male	HSV	67	Paracentral	7.5	HM	20/200
14	74	Male	Fungi	47	Peripheral	3.0	HM	20/400
15	34	Male	HSV	17	Paracentral	3.0	CF at 1m	20/200
16	62	Female	HSV	34	Central	7.5	HM	CF at 1m
17	51	Male	HSV	60	Central	7.5	HM	HM
18	62	Male	HSV	90	Central	7.0	HM	CF at 0.6m
19	62	Female	Bacteria	37	Central	7.5	HM	20/400
20	71	Female	HSV	18	Central	6.5	HM	CF at 1m
21	41	Male	HSV	30	Paracentral	7.0	CF at 2m	CF at 0.6m
22	48	Female	Fungi	90	Paracentral	5.5	CF at 2m	20/100
23	73	Male	Bacteria	90	Paracentral	7.5	CF at 0.6m	CF at 1m
24	75	Female	Bacteria	16	Paracentral	7.5	CF at 0.6m	20/400
25	69	Male	HSV	30	Central	7.5	HM	CF at 1m
26	67	Male	HSV	90	Central	7.5	HM	CF at 1m
27	64	Male	Bacteria	30	Peripheral	5.5	20/400	20/160
28	64	Female	HSV	26	Central	8.0	HM	CF at 0.6m
29	37	Female	HSV	30	Central	8.0	HM	20/400
30	47	Female	HSV	120	Paracentral	9.0	CF at 1m	CF at 1m
31	52	Male	Microsporidia	360	Central	8.0	HM	Failed
32	36	Female	HSV	360	Central	8.0	HM	20/160
33	67	Male	HSV	25	Central	8.0	HM	CF at 1m
34	57	Male	HSV	60	Paracentral	8.0	HM	Failed
35	60	Female	Bacteria	60	Paracentral	8.0	CF at 0.6m	20/400
36	69	Female	HSV	120	Paracentral	8.0	CF at 0.6m	20/120

Notes: DALK using anterior lamellar tissue after DSAEK preparation. DALK using corneas with low endothelial cell density.

Abbreviations: HSV, Herpes simplex virus; HM, Hand movement, CF, Counting fingers; Yrs., Years.

Table 4 Surgical Result by and Pathogen and Type of Grafts

Result	Success N (%)	Failure N (%)
By pathogen
Herpes Simplex	20 (95.2%)	1 (4.8%)
Bacteria	8 (100%)	0 (0%)
Fungi	5 (100%)	0 (0%)
Microsporidia	0 (0%)	2 (100%)
By type of grafts
Anterior corneal cap from pre-cut donor tissues used for DSAEK	26 (96.3%)	1 (3.7%)
Full thichness cornea with the low endothelial cell count	7 (77.8%)	2 (22.2%)

Figure 1 Two cases with successful surgery. Case 1. (A) 37-year-old female with a corneal perforation from Herpes Simplex keratitis. (B) Positive Seidel test. (C) Lamellar graft was performed with a good result at one-year follow-up (pre- and postoperative BCVA from hand movement to 20/200). Case 2. (D) A 69-year-old female with a corneal descemetocele from Herpes Simplex keratitis. (E) Negative Seidel test. (F) The graft was harvested from residual tissue after DSAEK. A good result was observed at one-year follow-up (pre and postoperative BCVA from hand movement to 20/120).