title: Deep anterior lamellar keratoplasty versus penetrating keratoplasty for macular corneal dystrophy: a randomized trial.
abstract: OBJECTIVE
  To compare outcomes of big-bubble deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) for macular corneal dystrophy.
  
  
  METHODS
  Prospective, randomized, interventional case series.
  
  
  METHODS
  setting: Single hospital. patients: Eighty-two eyes of 54 patients requiring keratoplasty for the treatment of macular corneal dystrophy without endothelial involvement were included. main outcome measures: Operative complications, uncorrected visual acuity, best-corrected visual acuity, contrast sensitivity function, higher-order aberrations, and endothelial cell density were evaluated.
  
  
  RESULTS
  The DALK and PK group consisted of 35 and 41 eyes, respectively. Best-corrected visual acuity after surgery was 20/40 or better 68.5% and 70.7% of the eyes in the DALK and PK groups, respectively (P > .05). No statistically significant differences between groups were found in contrast sensitivity function with and without glare for any spatial frequency (P > .05). Significantly higher levels of higher-order aberrations were found in the DALK group (P < .01). In both groups, a progressive and statistically significant reduction in endothelial cell density was found (P < .01). At the last follow-up, the mean endothelial cell loss was 18.1% and 26.9% in DALK and PK groups, respectively (P = .03). Graft rejection episodes were seen in 5 eyes (12.1%) in the PK group, and regrafting was necessary in 3 eyes (7.3%). Recurrence of the disease was documented in 5.7% and 4.8% of the eyes in the DALK and PK groups, respectively.
  
  
  CONCLUSIONS
  Deep anterior lamellar keratoplasty with the big-bubble technique provided comparable visual and optical results as PK and resulted in less endothelial damage, as well as eliminating endothelial rejection in macular corneal dystrophy. Deep anterior lamellar keratoplasty surgery is a viable option for macular corneal dystrophy without endothelial involvement.
authors.affiliation: Department of Ophthalmology, Medical Faculty, Balıkesir University, Balıkesir, Turkey. dresinsogutlu@gmail.com
authors.forename: Esin
authors.initials: E
authors.lastname: Sogutlu Sari
authors.forename: Anil
authors.initials: A
authors.lastname: Kubaloglu
authors.forename: Mustafa
authors.initials: M
authors.lastname: Unal
authors.forename: David
authors.initials: D
authors.lastname: Pinero
authors.forename: Nurullah
authors.initials: N
authors.lastname: Bulut
authors.forename: Muhammet Kazim
authors.initials: MK
authors.lastname: Erol
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Özertürk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002452:Cell Count; D015350:Contrast Sensitivity / Q000502:physiology; D003317:Corneal Dystrophies, Hereditary / Q000503:physiopathology / Q000601:surgery*; D016039:Corneal Transplantation; D057108:Corneal Wavefront Aberration / Q000175:diagnosis; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult