Eyeworld

47 EW FEATURE April 2015 Corneal lamellar surgical procedures DMEK graft underneath an anterior lamellar graft. Another approach is to fill the eye with air. Filling the anterior chamber with air requires an inferior iridotomy to prevent pupillary block, Dr. Price said. A 90% to 95% air fill that covers the area where the break is will allow it to heal. "The problem is if you have a break that sits at 6 o'clock, that can be a bit more problematic and hard to fix with an air bubble," Dr. Price said. "But if the break is at 12 o'clock, you can put in half an air fill, dilate the pupil, and that air will cover the break and give the bed it will cause the bubble to actually break—you can hear the pop in the operating room. If you go too fast—especially if there are any scars to Descemet's—you can get a split across Descemet's. If it starts in the center, that is pretty hard to sal- vage." Complications There are a variety of responses to unintentionally breaking through Descemet's membrane. Even in cases of a bad break, a surgeon can cut Descemet's all the way around and remove it, then sew in the graft and put the removed section similar to a time to adhere to the back of the donor graft." Another potential issue in DALK can arise with suture removal. Dr. Anwar said loosened sutures in the early postop period require imme- diate replacement. Otherwise he re- moves sutures selectively depending on the presence of astigmatism. "If the patient's vision corrects satisfactorily with glasses I tend not to remove sutures early," Dr. Anwar said. "I believe the graft should heal in that position for a longer period of time. Early removal can some- times result in significant wound dehiscence." EW Reference Sogutlu Sari, E. Penetrating keratoplasty versus deep anterior lamellar keratoplasty. Br J Ophthalmol. 2012;96(8):1063–1067. Editors' note: Drs. Price and Anwar have no financial interests related to their comments. Dr. John has financial interests with Bausch + Lomb (Bridgewater, N.J.) and ASICO (Westmont, Ill.). Contact information Anwar: dranwar00@yahoo.com John: lasikcornea@gmail.com Price: francisprice@pricevisiongroup.net EyeWorld Monthly Pulse EyeWorld Monthly Pulse is a reader survey on trends and patterns for the practicing ophthalmologist. Each month we send an online survey covering different topics so our readers can see how they compare to our survey. If you would like to join the hundreds of physicians who take a minute a month to share their views, please send us an email and we will add your name. Email carly@eyeworld.org and put EW Pulse in the subject line. Poll size: 139 Patient post-PK who had PRK Same patient Source: Francis W. Price, Jr., MD

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