Outcomes of deep anterior lamellar keratoplasty using the big-bubble technique in various corneal diseases.
OBJECTIVE
To report clinical outcomes of deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in various original diagnoses.


METHODS
Prospective interventional study.


METHODS
Single hospital study of 115 unselected consecutive patients (131 eyes) with various diagnoses undergoing DALK using the big-bubble technique. The main outcome measures were intraoperative and postoperative complications, postoperative best spectacle-corrected visual acuity (BSCVA), and endothelial cell density (ECD).


RESULTS
Descemet membrane was exposed successfully in 25 eyes (80.6%) with advanced keratoconus, 11 (73.3%) with chemical or thermal burns, 20 (71.4%) with corneal dystrophy, 21 (70%) with a herpes simplex (HSK) keratitis scar, 4 (36.4%) with moderate keratoconus, and 5 (31.3%) with a bacterial keratitis scar (P < .05). Loosening of the sutures occurred in 24 eyes (23.8%) between postoperative4 and 7 months. Epithelial rejection was observed in 2 eyes and stromal rejection occurred in 5 eyes. BSCVA was improved in HSK scarring and corneal dystrophy vs keratoconus and corneal burns at 1 year (P < .05), but not after a mean follow-up of 21.4 months (P < .05). Patients who experienced stromal rejection had lower ECD than patients with no rejection at 18 and 24 months (P < .05). At all follow-up times after 6 months, patients with multiple air injection attempts had lower ECD than patients with 1 injection attempt (P < .05).


CONCLUSIONS
Different Descemet membrane exposure rates were observed in different diagnoses using the big-bubble technique. Both severe stromal rejection and additional manipulation may have a deleterious effect on the corneal endothelium.
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. htls2009@yahoo.cn
Ting
T
Huang
Xueyan
X
Zhang
Yun
Y
Wang
Hong
H
Zhang
Andina
A
Huand
Na
N
Gao
D000328:Adult; D000388:Air; D002452:Cell Count; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D003886:Descemet Membrane / Q000601:surgery; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult