title: Deep anterior lamellar keratoplasty using the big-bubble technique for keratectasia after laser in situ keratomileusis.
abstract: OBJECTIVE
  To evaluate the efficacy of deep anterior lamellar keratoplasty (DALK) using the big-bubble technique to manage keratectasia after laser in situ keratomileusis (LASIK).
  
  
  METHODS
  Ophthalmology Department and Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  
  
  METHODS
  In this interventional case series, preoperative and postoperative data of patients who had post-LASIK ectasia and DALK using the Anwar big-bubble technique between April 2005 and May 2008 were compiled. Indications for keratoplasty were intolerance of rigid gas-permeable contact lenses or unacceptable corrected visual acuity. Preoperative and postoperative uncorrected (UDVA) and corrected (CDVA) distance visual acuities, spherical equivalent (SE) refractive error, mean keratometry, and keratometric astigmatism were compared.
  
  
  RESULTS
  The study included 11 eyes of 10 patients (mean age 31.6 years +/- 7.4 [SD]). The mean follow-up was 20.2 +/- 6.5 months. The mean UDVA increased from 20/400 before DALK to 20/160 after DALK (P = .39) and the CDVA, from 20/160 to 20/40, respectively (P = .007). The increase in the mean SE refractive error was 1.94 diopters (D) (from -11.53 +/- 5.4 D to -13.47 +/- 10.5 D) (P = .34). The mean keratometry was 46.81 +/- 7.2 D preoperatively and 46.31 +/- 1.9 D postoperatively (P = .81) and the mean keratometric astigmatism, 4.75 +/- 2.6 D and 4.55 +/- 2.5 D, respectively (P = .81), showing little change in either parameter.
  
  
  CONCLUSIONS
  Deep anterior lamellar keratoplasty using the big-bubble technique effectively restored corneal regularity and thus increased CDVA; however, a high refractive error should be expected postoperatively.
  
  
  BACKGROUND
  Neither author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: Ophthalmic Research Center and Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Javadi
authors.forename: Sepehr
authors.initials: S
authors.lastname: Feizi
mesh_terms: D000328:Adult; D000388:Air; D003315:Cornea / Q000473:pathology*; D003316:Corneal Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D004108:Dilatation, Pathologic / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications; D014792:Visual Acuity / Q000502:physiology