title: Diamond knife-assisted deep anterior lamellar keratoplasty to manage keratoconus.
abstract: OBJECTIVE
  To evaluate the outcomes of a new surgical technique, diamond knife-assisted deep anterior lamellar keratoplasty (DALK), and compare its visual and refractive results with big-bubble DALK in cases of keratoconus.
  
  
  METHODS
  Tertiary eyecare hospital.
  
  
  METHODS
  Comparative case series.
  
  
  METHODS
  The visual and surgical outcomes of diamond knife-assisted DALK were compared with those of successful big-bubble DALK.
  
  
  RESULTS
  Diamond knife-assisted DALK was performed in 19 eyes and big-bubble DALK, in 11 eyes. All surgeries were completed successfully. No intraoperative or postoperative complications occurred with diamond knife-assisted DALK. Six months after diamond knife-assisted DALK, the mean corrected distance visual acuity (CDVA) improved significantly from 1.87 logMAR ± 0.22 (SD) to 0.23 ± 0.06 logMAR, the mean keratometry improved from 65.99 ± 8.86 diopters (D) to 45.13 ± 1.16 D, and the mean keratometric cylinder improved from 7.99 ± 3.81 D to 2.87 ± 0.59 D (all P=.005). Postoperatively, the mean refractive astigmatism was 2.55 ± 0.49 D and the mean spherical equivalent was -1.97 ± 0.56 D. The mean logMAR CDVA (P = .06), postoperative keratometry (P=.64), refractive cylinder (P=.63), and endothelial cell loss (P=.11) were comparable between diamond knife-assisted DALK and big-bubble DALK.
  
  
  CONCLUSIONS
  Diamond knife-assisted DALK was effective and predictable as a surgical technique for management of keratoconus cases. This technique has the potential to offer visual and refractive outcomes comparable to those of big-bubble DALK.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From Dr. Rajendra Prasad Centre for Ophthalmic Sciences (Vajpayee, Maharana, Sharma, Agarwal), All India Institute of Medical Sciences, New Delhi, India; the Centre for Eye Research Australia (Vajpayee, Jhanji), University of Melbourne, Australia; the Department of Ophthalmology and Visual Sciences (Jhanji), Chinese University of Hong Kong, Hong Kong. Electronic address: rasikv@unimelb.edu.au.
authors.forename: Rasik B
authors.initials: RB
authors.lastname: Vajpayee
authors.affiliation: From Dr. Rajendra Prasad Centre for Ophthalmic Sciences (Vajpayee, Maharana, Sharma, Agarwal), All India Institute of Medical Sciences, New Delhi, India; the Centre for Eye Research Australia (Vajpayee, Jhanji), University of Melbourne, Australia; the Department of Ophthalmology and Visual Sciences (Jhanji), Chinese University of Hong Kong, Hong Kong.
authors.forename: Prafulla K
authors.initials: PK
authors.lastname: Maharana
authors.affiliation: From Dr. Rajendra Prasad Centre for Ophthalmic Sciences (Vajpayee, Maharana, Sharma, Agarwal), All India Institute of Medical Sciences, New Delhi, India; the Centre for Eye Research Australia (Vajpayee, Jhanji), University of Melbourne, Australia; the Department of Ophthalmology and Visual Sciences (Jhanji), Chinese University of Hong Kong, Hong Kong.
authors.forename: Namrata
authors.initials: N
authors.lastname: Sharma
authors.affiliation: From Dr. Rajendra Prasad Centre for Ophthalmic Sciences (Vajpayee, Maharana, Sharma, Agarwal), All India Institute of Medical Sciences, New Delhi, India; the Centre for Eye Research Australia (Vajpayee, Jhanji), University of Melbourne, Australia; the Department of Ophthalmology and Visual Sciences (Jhanji), Chinese University of Hong Kong, Hong Kong.
authors.forename: Tushar
authors.initials: T
authors.lastname: Agarwal
authors.affiliation: From Dr. Rajendra Prasad Centre for Ophthalmic Sciences (Vajpayee, Maharana, Sharma, Agarwal), All India Institute of Medical Sciences, New Delhi, India; the Centre for Eye Research Australia (Vajpayee, Jhanji), University of Melbourne, Australia; the Department of Ophthalmology and Visual Sciences (Jhanji), Chinese University of Hong Kong, Hong Kong.
authors.forename: Vishal
authors.initials: V
authors.lastname: Jhanji
mesh_terms: D000293:Adolescent; D000328:Adult; D001251:Astigmatism / Q000503:physiopathology; D002648:Child; D003315:Cornea / Q000503:physiopathology; D063171:Corneal Pachymetry; D016039:Corneal Transplantation / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D012029:Refraction, Ocular / Q000502:physiology; D014019:Tissue Donors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult