Incidence and Factors Related to Double Anterior Chamber Complications After Deep Anterior Lamellar Keratoplasty.

Background: Deep anterior lamellar keratoplasty (DALK) has safety advantages over penetrating keratoplasty. However, one of the serious complications of DALK is Descemet membrane (DM) detachment, which can lead to double anterior chamber (DAC) and visual impairment. This study examines the incidence and factors related to the complication of DAC after DALK, including preexisting conditions such as atopic dermatitis (AD).

Methods: This is a retrospective evaluation of all patients who underwent DALK from January 2019 to April 2024 in the Department of Ophthalmology, Fukuoka University Hospital. Cases with DAC postoperatively were analyzed statistically. A total of 85 eyes in 73 patients were included. We excluded eyes with preexisting corneal perforations that required grafts that were less than 6mm in diameter. A binomial logistic predictive model was used to determine factors associated with postoperative DAC. Collated variables were age, AD, preexisting corneal diseases, donor button size, intraoperative DM perforation, and cornea supply source.

Results: Among 85 eyes that underwent DALK, 12 eyes (14.1%) developed postoperative DAC. Binomial regression analysis revealed preexisting corneal diseases (p=0.031) including preoperative DM perforation, infectious keratitis, keratoconus, corneal dystrophy, and corneal scar, intra-operative DM perforation (p=0.049), and AD (p=0.031) to be significant factors associated with DAC. This binomial regression model had 83.3% sensitivity and 78.0% specificity.

Conclusion: AD and preexisting corneal diseases were significant factors in DAC after DALK, and DALK during active infection predisposes to DAC, while intraoperative perforation was also significantly associated. Our study suggests that these factors could be of importance in considering the mechanism of pathogenesis of DM and DAC.