title: Deep anterior lamellar keratoplasty using big-bubble technique for treatment of corneal stromal scars.
abstract: OBJECTIVE
  To report the clinical outcomes of deep anterior lamellar keratoplasty (DALK) in patients with anterior corneal stromal scars associated with various etiologies.
  
  
  METHODS
  A total of 79 eyes of 79 patients with corneal stromal scars sparing the Descemet membrane and the endothelium underwent DALK by using big-bubble technique. The main outcome measures of the study were the ability to successfully complete DALK, intraoperative and postoperative complications, best spectacle-corrected visual acuity, refraction, and graft clarity.
  
  
  RESULTS
  Seventy-two of the surgical procedures were carried out as DALK, and the mean follow-up time was 28.1 ± 17.9 months (range, 12-78 months). The most frequent indication for DALK surgery was postherpetic keratitis (44%). Complete Descemet membrane exposure via big bubble (descemetic DALK) could be achieved in 57 cases (79%). Fifteen eyes (21%) required layer-by-layer manual dissection (predescemetic DALK). Best spectacle-corrected visual acuity of 6/12 or better was present in 59 eyes (82%) postoperatively. The mean spherical equivalent and topographic astigmatism were -3.32 ± 2.13 (range, -9.13 to +4.75) and -2.97 ± 1.94 (range, -8.0 to +4.50) diopter, respectively. There were 2 instances of stromal graft rejection, which responded to medical therapy.
  
  
  CONCLUSIONS
  DALK big-bubble technique may be a valuable and safe treatment in patients with corneal stromal scar with healthy endothelium. The visual and refractive outcomes are comparable to standard penetrating keratoplasty, avoiding the risk of endothelial rejection.
authors.affiliation: Department of Ophthalmology, İstanbul University Cerrahpaşa Medical Faculty, Cerrahpaşa, İstanbul, Turkey.
authors.forename: Osman Sevki
authors.initials: OS
authors.lastname: Arslan
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ünal
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Tuncer
authors.forename: Iclal
authors.initials: I
authors.lastname: Yücel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002921:Cicatrix / Q000503:physiopathology / Q000601:surgery*; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D003319:Corneal Stroma / Q000503:physiopathology / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012029:Refraction, Ocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology