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.