Comparison of techniques used for removing the recipient stroma in anterior lamellar keratoplasty.
OBJECTIVE
To compare 3 techniques used for removing the recipient stroma during anterior lamellar keratoplasty (ALK): the "big-bubble" technique, manual dissection using a crescent blade and slitlamp operating microscope, and microkeratome lamellar cut.


METHODS
Retrospective comparative cohort study of 69 consecutive ALKs and 69 consecutive penetrating keratoplasties (PKs). Manifest refraction, slitlamp examination, Goldmann tonometry, ultrasound pachymetry, specular microscopy, and confocal microscopy findings were recorded.


RESULTS
The 12-month graft survival estimate was 98.5% in the ALK group and 94.1% in the PK group (P = .19). Higher endothelial cell density was found after ALK (P < .001). At 12 months (before suture removal), 53% of eyes that underwent ALK and 44% of eyes that underwent PK had 20/40 or better spectacle-corrected visual acuity (P = .24). In keratoconic eyes, these values were 83% and 69%, respectively (P = .18). Significant differences in visual acuity, corneal central thickness, and keratocyte density among ALK subgroups were found, with the best results obtained using the big-bubble technique and the worst results obtained using the microkeratome. In eyes that underwent ALK, visual acuity increased with keratocyte density.


CONCLUSIONS
Better results were obtained after ALK vs PK, and the big-bubble technique seemed to provide the best results.
Borderie
Vincent M
VM
Centre Hospitalier National d'Ophtalmologie des XV-XX, 28 rue de Charenton, 75012, Paris, France. borderie@quinze-vingts.fr
Werthel
Andrée-Luce
AL
Touzeau
Olivier
O
Allouch
Cécile
C
Boutboul
Sandrine
S
Laroche
Laurent
L
D000328:Adult; D000368:Aged; D002452:Cell Count; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D003319:Corneal Stroma / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000379:methods; D018613:Microscopy, Confocal; D012029:Refraction, Ocular / Q000502:physiology; D012189:Retrospective Studies; D014019:Tissue Donors; D014792:Visual Acuity / Q000502:physiology