Deep Anterior Lamellar Keratoplasty in Patients with Keratoconus: Big-Bubble Technique

Purpose: To evaluate the visual and refractive outcomes after deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in eyes with keratoconus. Methods: In this case series, eyes with moderate to advanced keratoconus underwent DALK. All of them had unacceptable spectacle-corrected visual acuity or were contact lens intolerant. DALK was performed using the big-bubble technique. Full thickness donor cornea without Descemet's membrane (DM) was sutured to the recipient bed with three different suturing techniques. The visual acuity (presented in logMAR), refractive status, intraoperative and postoperative complications were evaluated. Results: A total of 129 consecutive eyes of 121 patients were included. In 3 eyes, the operation was converted to penetrating keratoplasty. Therefore, 126 eyes (79 male) were enrolled in the study. Mean patient age at the time of surgery was 26.08 ± 7.6 years. Mean follow-up period was 21.62 ± 9.0 months. Mean preoperative corrected visual acuity was 1.27 ± 0.4 logMAR, increasing to 0.25 ± 0.2 logMAR at final follow-up examination (P < 0.001). Postoperative mean spherical equivalent refractive error, refractive and keratometric astigmatism were −3.41 ± 3.1 D, 3.04 ± 2.3 D, and 3.67 ± 2.1 D, respectively. Bared DM was achieved in 103 eyes, whereas in 23 eyes pre-Descemet dissection was performed. DM perforation occurred in 5 eyes. The main complications encountered were filamentary keratitis, subepithelial graft rejection, and astigmatism. Conclusions: DALK using the big-bubble technique appears to be a safe and effective procedure for eyes with moderate to advanced keratoconus. In case of extensive intraoperative DM perforation, it does not pose any limitation to ongoing penetrating keratoplasty.

[1]  U. Rampal,et al.  Relaxing incisions combined with adjustment sutures for post-deep anterior lamellar keratoplasty astigmatism in keratoconus. , 2011, Cornea.

[2]  M. Kanavi,et al.  Indications for Penetrating Keratoplasty in Iran , 2007, Cornea.

[3]  B. Ilango.  Comparative cohort study of the outcomes of deep lamellar keratoplasty and penetrating keratoplasty for keratoconus , 2007, Eye.

[4]  S. Tuft,et al.  Quality of vision and graft thickness in deep anterior lamellar and penetrating corneal allografts. , 2007, American journal of ophthalmology.

[5]  B. Zuberbuhler,et al.  Deep Anterior Lamellar Keratoplasty (DALK): Visual Outcome and Complications for a Heterogeneous Group of Corneal Pathologies , 2007, Cornea.

[6]  Luigi Fontana,et al.  Clinical outcomes after deep anterior lamellar keratoplasty using the big-bubble technique in patients with keratoconus. , 2007, American journal of ophthalmology.

[7]  D. Ritterband,et al.  Efficacy and Safety of Moxifloxacin as an Additive in Optisol-GS a Preservation Medium for Corneal Donor Tissue , 2006, Cornea.

[8]  S. Tuft,et al.  Patterns of rejection after deep lamellar keratoplasty. , 2006, Ophthalmology.

[9]  E. Cohen,et al.  Wound Dehiscence After Penetrating Keratoplasty , 2006, Cornea.

[10]  P. Padmanabhan,et al.  Results of deep lamellar keratoplasty using the big-bubble technique in patients with keratoconus. , 2006, American journal of ophthalmology.

[11]  W. V. Van Meter,et al.  Effect of death-to-preservation time on donor corneal epithelium. , 2005, Transactions of the American Ophthalmological Society.

[12]  A. Solomon,et al.  Forty Years of Changing Indications in Penetrating Keratoplasty in Israel , 2005, Cornea.

[13]  Catey Bunce,et al.  Comparison of deep lamellar keratoplasty and penetrating keratoplasty in patients with keratoconus. , 2002, Ophthalmology.

[14]  A. Jain,et al.  Indications and Outcome of Optical Partial Thickness Lamellar Keratoplasty , 2003, Cornea.

[15]  K. Tsubota,et al.  Randomized clinical trial of deep lamellar keratoplasty vs penetrating keratoplasty. , 2002, American journal of ophthalmology.

[16]  M. Anwar,et al.  Deep Lamellar Keratoplasty: Surgical Techniques for Anterior Lamellar Keratoplasty With and Without Baring of Descemet's Membrane , 2002, Cornea.

[17]  Mohammed Anwar,et al.  Big‐bubble technique to bare Descemet's membrane in anterior lamellar keratoplasty , 2002, Journal of cataract and refractive surgery.

[18]  C. McGhee,et al.  Indications for Corneal Transplantation in New Zealand: 1991–1999 , 2002, Cornea.

[19]  F. Trimarchi,et al.  Deep Lamellar Keratoplasty , 2001, Ophthalmologica.

[20]  J. Legeais,et al.  Nineteen Years of Penetrating Keratoplasty in the Hotel-Dieu Hospital in Paris , 2001, Cornea.

[21]  J. Kirwan,et al.  Deep lamellar keratoplasty with lyophilised tissue in the management of keratoconus , 2001, The British journal of ophthalmology.

[22]  M. Terry.  The Evolution of Lamellar Grafting Techniques Over Twenty-five Years , 2000, Cornea.

[23]  J. Shimazaki.  The evolution of lamellar keratoplasty. , 2000, Current opinion in ophthalmology.

[24]  E. Manche,et al.  Deep lamellar keratoplasty using viscoelastic dissection. , 1999, Archives of ophthalmology.

[25]  A. Geerards,et al.  The future of lamellar keratoplasty. , 1999, Current opinion in ophthalmology.

[26]  J. Singh,et al.  Deep lamellar keratoplasty versus penetrating keratoplasty for corneal lesions. , 1999, Cornea.

[27]  K. Tsubota,et al.  A new surgical technique for deep lamellar keratoplasty with single running suture adjustment. , 1998, American journal of ophthalmology.

[28]  J. Kirwan,et al.  Corneal endothelial specular microscopy following deep lamellar keratoplasty with lyophilised tissue , 1998, Eye.

[29]  A. Loewenstein,et al.  Deep lamellar keratoplasty with complete removal of pathological stroma for vision improvement , 1998, The British journal of ophthalmology.

[30]  M. Lynn,et al.  Donor factors associated with epithelial defects after penetrating keratoplasty. , 1996, Cornea.

[31]  E. Cohen,et al.  Factors associated with epithelial defects after penetrating keratoplasty. , 1994, Ophthalmic surgery.

[32]  T. Prager,et al.  Visual improvement as a function of time after lamellar keratoplasty for keratoconus. , 1993, American journal of ophthalmology.

[33]  E A Archila,et al.  Deep lamellar keratoplasty dissection of host tissue with intrastromal air injection. , 1984, Cornea.

[34]  A. Gasset,et al.  A comparison of penetrating keratoplasty and lamellar keratoplasty in the surgical management of keratoconus. , 1978, American journal of ophthalmology.

[35]  A. Gasset,et al.  A COMPARISON OF PK AND LAMELLAR KERATOPLASTY IN THE SURGICAL MANAGEMENT OF KERATOCONUS , 1978 .