title: Deep anterior lamellar keratoplasty with Intacs explantation in keratoconus.
abstract: OBJECTIVE
  To describe the surgical technique and clinical outcome of deep anterior lamellar keratoplasty (DALK) with Intacs explantation in patients with poor visual outcome after Intacs implantation for keratoconus correction.
  
  
  METHODS
  Two patients with bilateral keratoconus underwent Intacs segment implantation. Due to poor visual outcome and patient dissatisfaction, the Intacs segments were explanted and a big bubble-assisted DALK procedure was performed at the time of Intacs removal.
  
  
  RESULTS
  DALK could be successfully completed in both cases. There were no postoperative complications. At 2 years follow-up, the grafts were clear in both patients, with a best spectacle-corrected visual acuity of 20/25.
  
  
  CONCLUSIONS
  A modified big bubble-assisted DALK procedure can be performed in keratoconic eyes requiring Intacs explantation and may provide a better alternative to a penetrating keratoplasty.
authors.affiliation: Cornea and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Jeewan S
authors.initials: JS
authors.lastname: Titiyal
authors.forename: Bhavna
authors.initials: B
authors.lastname: Chawla
authors.forename: Namrata
authors.initials: N
authors.lastname: Sharma
mesh_terms: D000328:Adult; D003319:Corneal Stroma / Q000601:surgery*; D016039:Corneal Transplantation; D020878:Device Removal; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000601:surgery*; D008297:Male; D019904:Polymethyl Methacrylate; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D016896:Treatment Outcome; D014786:Vision Disorders / Q000601:surgery; D014792:Visual Acuity; D055815:Young Adult
chemical_list: D019904:Polymethyl Methacrylate