{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:28:31Z","timestamp":1786739311961,"version":"build-2736575974"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To evaluate the outcome of eyes with large Descemet's membrane (DM) perforation during deep anterior lamellar keratoplasty (DALK).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective, interventional case series of 12 eyes with completed DALK, despite DM perforation larger than 4 mm in its widest dimension. The main outcome measures included graft clarity, endothelial cell density (ECD), corrected distance visual acuity (CDVA), and DM detachment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The mean age of patients was 26.8 \u00b1 11.4 years. Preoperative pathology included keratoconus (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 10), macular dystrophy (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 1), and postmicrobial keratitis corneal scar (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 1). The average size of DM perforation was 6.5 mm \u00b1 1.3 mm. At the end of the follow-up period (median 15 months, range 6\u201353 months), the mean CDVA was 0.32 \u00b1 0.09 logMAR and the mean ECD was 1830.8 \u00b1 299.7 cells\/mm\n                      <jats:sup>2<\/jats:sup>\n                      . Nine patients (75%) developed DM detachments postoperatively and was managed by intracameral air injection once in six eyes, and twice in three eyes. Other complications included persistent localized stromal edema at the site of DM defect in one eye and Urrets Zavalia syndrome in one eye.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Completing DALK in eyes with large DM perforation provides good visual acuity, endothelial cell count and may be superior to penetrating keratoplasty regarding long-term graft survival if confirmed in future comparative studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/2452-2325.303199","type":"journal-article","created":{"date-parts":[[2021,7,15]],"date-time":"2021-07-15T06:19:19Z","timestamp":1626329959000},"page":"171-176","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Deep Anterior Lamellar Keratoplasty with Large Descemet's Membrane 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