title: Results of deep lamellar keratoplasty using the big-bubble technique in patients with keratoconus.
abstract: OBJECTIVE
  To evaluate the efficacy of deep lamellar keratoplasty using the big-bubble technique in patients with keratoconus.
  
  
  METHODS
  Interventional case series.
  
  
  METHODS
  Thirteen eyes of 12 patients (eight male and four female subjects) with moderate to advanced keratoconus and intolerance to contact lens wear were included in this study. Deep lamellar keratoplasty was performed by the intrastromal air injection technique. Full-thickness donor tissue devoid of Descemet membrane and endothelium was then sutured into place. Best-corrected visual acuity, refractive results, surgical technique, and complication rates were analyzed.
  
  
  RESULTS
  Big bubble was successfully achieved in nine eyes (69.2%). Average postoperative best-corrected visual acuity was 20/25 (range 20/50 to 20/20) at a mean follow-up of 5 months. Intraoperative microperforation of Descemet membrane occurred in two eyes (15.3%). Three eyes (23%) developed a steroid-induced increase in intraocular pressure, which responded to medical therapy.
  
  
  CONCLUSIONS
  Deep lamellar keratoplasty that uses the big-bubble technique is safe and effective in patients with keratoconus. Visual outcome is comparable to standard penetrating keratoplasty, without the risk of endothelial rejection.
authors.affiliation: Cornea Services, Sankara Nethralaya, Medical and Vision Research Foundations, Chennai, Tamil Nadu, India. dr_fogla@yahoo.com
authors.forename: Rajesh
authors.initials: R
authors.lastname: Fogla
authors.forename: Prema
authors.initials: P
authors.lastname: Padmanabhan
mesh_terms: D000293:Adolescent; D000328:Adult; D000388:Air; D003319:Corneal Stroma; D016039:Corneal Transplantation / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007640:Keratoconus / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications; D016896:Treatment Outcome; D014792:Visual Acuity