Comparative evaluation of big-bubble deep anterior lamellar keratoplasty and penetrating keratoplasty in a case of macular corneal dystrophy.
OBJECTIVE
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.
Bridgend Eye Unit, Princess of Wales Hospital, Bridgend, United Kingdom. amitpatel@doctors.org.uk
Amit K
AK
Patel
Harish
H
Nayak
Vinod
V
Kumar
D000388:Air; D003317:Corneal Dystrophies, Hereditary / Q000150:complications / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D005139:Eyeglasses; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation; D014792:Visual Acuity