title: [Preliminary clinical results of deep anterior lamellar keratoplasty in the treatment deep infectious purulent keratitis].
abstract: OBJECTIVE
  To evaluate the clinical results of deep anterior lamellar keratoplasty (DALK) assisted by big bubble technique in the treatment of deep infectious purulent keratitis.
  
  
  METHODS
  Seventeen patients (17 eyes) with deep infectious purulent keratitis received DALK surgery in Shandong Eye Hospital from January 2011 to March 2012. Case selection:Patients with purulent keratitis, the infection or infiltrate depth was more than four fifth corneal thickness;
  
  
  METHODS
  Use DALK assisted by big bubble technique to cut off the lesions and expose the Descemet's membrane. The prepared donor which stored in D-X medium or in glycerine preoperatively was oversized by 0.25 mm, and after stripping of Descemet's membrane, the donor button was interrupted sutured with 10-0 nylon suture. The perioperative complications, recurrence, graft status and visual recovery were evaluated.
  
  
  RESULTS
  The mean follow up time were 9 months.17 patients with average age of (46 ± 13) year old received DALK surgery, including 14 cases of fungal keratitis and 3 cases of bacteria keratitis. Perioperative complications:Two cases suffered micro perforation and were continuing performed DALK surgery after injecting air bubble in the anterior chamber. Three cases suffered double anterior chamber, one was resolved after graft resuture, and the other two were absorbed automatically.One patient suffered fungal recurrence and cured with secondary penetrating keratoplasty. Graft status:All grafts attached closely to the recipients, slit lamp and AS-OCT examinations were difficult to distinguish the interface. All of grafts were transparent. Visual acuity:before the operation best corrected visual acuity (BCVA) in patients with HM/20 cm to 3.7, after the surgery patients' BSCVA improved to 4.5-5.0. The mean astigmatism postoperatively of 16 cases received successful DALK finally was (4.53 ± 2.35) D .
  
  
  CONCLUSIONS
  For patients with deep infectious purulent keratitis, big bubble technique assistants DALK surgery is still a safe and effective method.
authors.affiliation: Shangdong Eye Institute, Shandong Eye Hospital, Jinan 250021, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Gao
authors.affiliation: Shangdong Eye Institute, Shandong Eye Hospital, Jinan 250021, China.
authors.forename: Yan-ni
authors.initials: YN
authors.lastname: Jia
authors.affiliation: Shangdong Eye Institute, Shandong Eye Hospital, Jinan 250021, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Ding
authors.affiliation: Shangdong Eye Institute, Shandong Eye Hospital, Jinan 250021, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Song
authors.affiliation: Shangdong Eye Institute, Shandong Eye Hospital, Jinan 250021, China.
authors.forename: Su-xia
authors.initials: SX
authors.lastname: Li
authors.affiliation: Shangdong Eye Institute, Shandong Eye Hospital, Jinan 250021, China.
authors.forename: Shu-ting
authors.initials: ST
authors.lastname: Wang
authors.affiliation: Shangdong Eye Institute, Shandong Eye Hospital, Jinan 250021, China. Email: weiyunshi@163.com.
authors.forename: Wei-yun
authors.initials: WY
authors.lastname: Shi
mesh_terms: D000328:Adult; D000368:Aged; D016039:Corneal Transplantation / Q000379:methods*; D003886:Descemet Membrane / Q000601:surgery*; D005260:Female; D006801:Humans; D007634:Keratitis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013492:Suppuration