title: [Deep anterior lamellar keratoplasty by big-bubble technique].
abstract: OBJECTIVE
  To evaluate the efficacy, safety, and complications related to the deep anterior lamellar keratoplasty (DALK) using the big-bubble technique.
  
  
  METHODS
  A prospective study of patients submitted to DALK using the big-bubble technique was conducted. After the procedure, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical equivalent (SE), corneal topography, endothelial cell density, and intraoperative and postoperative complications were evaluated.
  
  
  RESULTS
  Fifty-nine eyes of 55 patients were included in this study. Mean follow-up period was 16 ± 7.4 months. Baseline mean UCVA (logMAR) and BCVA was 1.60 ± 0.33 and 1.00 ± 0.43, respectively. After 12 months, the mean UCVA and BCVA improved to 0.86 ± 0.39 and 0.17 ± 0.14, respectively. Mean SE improved from -8.21 ± 3.91 to -1.82 ± 3.62 at 12 months. Mean topographic astigmatism improved from -7.9 ± 3.7 to -2.21 ± 1.7 at 12 months. Mean preoperative endothelial cell density was 2,377.98 ± 263.56 cells/mm², after 12 months of surgery the mean endothelial cell density reduced to 1,851.32 ± 397.61 cells/mm². Intraoperative microperfuration occurred in 6 cases (10.2%). One patient developed stromal rejection, and one patient developed fixed dilated pupil (Urrets-Zavalia Syndrome) after the procedure.
  
  
  CONCLUSIONS
  Nevertheless, deep anterior lamellar keratoplasty is more technically challenging, yet rewarding choice of surgery for keratoplasty patients who have a healthy endothelial cell count. ClinicalTrials.gov Identifier: NCT00887900.
authors.affiliation: Departamento de Córnea, Doenças Externas e Catarata, Hospital Oftalmológico de Brasília - HOB - Brasília (DF), Brazil. tzelikis@terra.com.br
authors.forename: Patrick Frensel de Moraes
authors.initials: PF
authors.lastname: Tzelikis
authors.forename: Juliana Dias dos
authors.initials: JD
authors.lastname: Santos
authors.forename: Rodrigo Castro
authors.initials: RC
authors.lastname: Garcez
authors.forename: Leonardo
authors.initials: L
authors.lastname: Akaishi
mesh_terms: D000293:Adolescent; D000328:Adult; D003316:Corneal Diseases / Q000601:surgery*; D019781:Corneal Topography; D016039:Corneal Transplantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult