Frequency and nature of complications of deep anterior lamellar keratoplasty

OBJECTIVE: The study analyzed intraoperative and postoperative complications of deep anterior lamellar keratoplasty (DALK) performed in 2008-2023 at the Krasnov Research Institute of Eye Diseases. MATERIAL AND METHODS: This retrospective study included 523 patients (548 eyes) with corneal pathology: keratoconus, post-refractive keratectasia, pellucid marginal degeneration, stromal dystrophies, and opacities due to keratitis or trauma. All patients underwent DALK using the big-bubble technique. The maximum follow-up period was 15 years; follow-up exceeded 5 years in 373 cases, and 10 years in 175 cases. RESULTS: Type 1 Descemet membrane (DM) detachment was recorded in 434 cases, type 2 - in 51 cases, and type 3 - in 8 cases. In 55 eyes, DM detachment using the big-bubble technique was not possible, in these cases DM was separated from the stroma with a dissector. The main intraoperative complications were DM damage during needle insertion into the stroma (2.2%), during stromectomy (0.5%), or during corneal suture placement (2.7%). Early postoperative complications included a false chamber between the graft and the patient's DM (0.9%), delayed graft epithelialization (20.4%), and acute graft rejection (2.2%). Late postoperative complications included acute graft rejection (1.1%), chronic graft rejection (1.1%), suture cut-through or loosening (1.6%), suture-related infiltrates (0.5%), ocular hypertension (3.1%), and posterior capsular cataract (2.9%). CONCLUSION: DALK offers the advantage of a relatively low risk of damage to intraocular structures and tissue incompatibility reactions. When intraoperative and postoperative complications of DALK occur, additional surgical interventions or adjustment of drug therapy are required.