Comparative Evaluation of Big-Bubble Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty in a Case of Macular Corneal Dystrophy

Purpose: A case of a 54-year-old patient with macular corneal dystrophy who underwent a penetrating keratoplasty (PK) in the left eye and a deep anterior lamellar keratoplasty (DALK) in the right eye is described. The merits of PK versus DALK for visual rehabilitation in macular corneal dystrophy are discussed. Methods: After deep lamellar dissection in the left eye, the remaining bed of residual stroma, Descemet membrane, and endothelium was unacceptably hazy and thus converted to PK. The right eye had successful DALK because a relatively clear bed was noted after deep lamellar separation using the big-bubble technique. Results: The spectacle-corrected visual acuities at 2-year follow-up are 6/6 OD and 6/9+ OS. There is mild residual haze in the right eye, although the visual acuity is better in this eye. Endothelial cell counts were satisfactory and not significantly different in both eyes. Conclusions: This case demonstrates that DALK with the big-bubble technique can be successfully carried out for visual rehabilitation in macular dystrophy. DALK should be considered in cases with no significant Descemet membrane and endothelial involvement because of the potential advantages offered by retaining the host endothelium.