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Blunt Cannula for Descemetic Deep Anterior Lamellar Keratoplasty

Sarnicola, Vincenzo MD; Toro, Patricia MD

doi: 10.1097/ICO.0b013e3181e848c3
Clinical Science

Purpose: To evaluate the success of using a cannula for descemetic deep anterior lamellar keratoplasty (dDALK) and the frequency of Descemet perforation using the new Sarnicola deep anterior lamellar keratoplasty (DALK) cannula and spatula.

Methods: Retrospective study of medical records of 28 eyes of 28 patients who underwent the DALK procedure between December 2008 and February 2009 using the blunt Sarnicola spatula and cannula. Main outcomes analyzed were the frequency of dDALK and pre-dDALK, the frequency of big-bubble and air-visco bubble formation, and the frequency of Descemet rupture during the procedure.

Results: In 26 cases (93%), we achieved dDALK dissection; 2 cases (7%) were pre-dDALK. Big-bubble formation occurred in 24 cases (86%); in 2 cases (7%), an air-visco bubble was formed. No perforations of Descemet membrane occurred during air injection in an attempt to form a big bubble. A rupture of Descemet membrane occurred in 1 case (3.5%) during peripheral stromal excision.

Conclusions: The smooth Sarnicola DALK spatula and cannula facilitate a high percentage of dDALK and make the maneuver more manageable compared to air injection with a needle.

From the Department of Ophthalmology, Misericordia Hospital, Universita degli Studi di Siena, Grosseto, Italy.

Received for publication September 4, 2009; revision received April 26, 2010; accepted May 1, 2010.

Reprints: Vincenzo Sarnicola, Department of Ophthalmology, Misericordia Hospital, Via Mazzini, 62, 58100 Grosseto, Toscana, Italy (e-mail:

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