title: Long-term results of deep anterior lamellar keratoplasty for the treatment of keratoconus.
abstract: OBJECTIVE
  To evaluate the long-term endothelial cell density (ECD) changes and visual and refractive outcomes after deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in eyes with keratoconus.
  
  
  METHODS
  Retrospective interventional case series study.
  
  
  METHODS
  setting: Single hospital. patients: Two hundred forty-one eyes of 214 patients who underwent DALK for moderate to advanced keratoconus. main outcome measures: Intraoperative and postoperative complications, postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), spherical equivalent refraction, topographic astigmatism, and ECD.
  
  
  RESULTS
  Two hundred thirty-four procedures (97%) were completed as DALK. Big bubble was successfully achieved in 193 eyes (82.4%). In 7 eyes (3%), the procedure was converted to penetrating keratoplasty because of Descemet membrane macroperforations. Microperforations occurred in 18 eyes (7.5%). The mean follow-up time was 50.5 ± 22.2 months (range 24 to 96 months). UCVA was lower than 20/100 in all eyes preoperatively and better than 20/100 in 191 eyes (81.6%) postoperatively. BSCVA was 20/40 or better in 187 eyes (79.9%) and 20/20 or better in 38 eyes (16.2%). The mean (± SD) preoperative ECD that was possible in 166 eyes was 2797 ± 561 cells/mm(2). Mean (± SD) endothelial cell loss was 8.1% ± 4.6% at 1 year, 10.5% ± 5.7% at 2 years, 15.1% ± 14.8% at 6 years, and 22.5% ± 15.9% at 8 years. Stromal graft rejection episodes occurred in 4 eyes, which resolved with appropriate therapy.
  
  
  CONCLUSIONS
  Deep anterior lamellar keratoplasty that uses the big-bubble technique is effective in patients with keratoconus. Long-term endothelial cell loss was moderate and lower than penetrating keratoplasty grafts.
authors.affiliation: Kartal Training and Research Hospital Eye Clinic, Istanbul, Turkey.
authors.forename: Anil
authors.initials: A
authors.lastname: Kubaloglu
authors.forename: Esin Sögütlü
authors.initials: ES
authors.lastname: Sari
authors.forename: Mustafa
authors.initials: M
authors.lastname: Unal
authors.forename: Arif
authors.initials: A
authors.lastname: Koytak
authors.forename: Ekrem
authors.initials: E
authors.lastname: Kurnaz
authors.forename: Yasin
authors.initials: Y
authors.lastname: Cinar
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Ozertürk
mesh_terms: D000293:Adolescent; D000328:Adult; D001251:Astigmatism / Q000503:physiopathology; D002452:Cell Count; D002648:Child; D055954:Corneal Endothelial Cell Loss / Q000503:physiopathology; D016039:Corneal Transplantation; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D007640:Keratoconus / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012029:Refraction, Ocular / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology