title: Modified deep anterior lamellar keratoplasty for the treatment of advanced keratoconus with steep corneal curvature to help in eliminating the wrinkles in the Descemet's membrane.
abstract: OBJECTIVE
  To determine the clinical efficacy of modified deep anterior lamellar keratoplasty (DALK) for the treatment of advanced-stage keratoconus with steep curvature.
  
  
  METHODS
  In this interventional, non-comparative case series, 30 patients with advanced stages of keratoconus and curvature of more than 60 D underwent a modified DALK procedure. In this technique, after big-bubble formation, posterior stromal lamella was cut and removed 5 mm centrally (baring Descemet's membrane completely) with posterior stromal layer remaining peripherally.
  
  
  RESULTS
  The study included 30 eyes (30 patients with a mean ± SD age of 25 ± 5.4 years). The follow-up examination was performed for all participants up to 12 months after the surgery. The mean uncorrected visual acuity (UCVA) increased from 20/800 before the surgery to a subsequent 3/10 (P = 0.12). Likewise, best spectacle corrected visual acuity (BSCVA) improved, reaching 6/10 postoperatively (former quantity 20/200) (P = 0.18). In addition, mean keratometry and keratometric astigmatism managed to achieve considerable improvement, from 58.8 ± 5.4 D to 46.5 ± 2.1 D and 7.8 ± 2.1 to 4.54 ± 1.54 D, respectively (P = 0.52). Descemet's membrane wrinkling was not seen in any patient postoperatively.
  
  
  CONCLUSIONS
  This technique is effective in restoring acceptable vision and corneal regularity in advanced cases of keratoconus with a curvature more than 60 D who are also at risk of Descemet's membrane wrinkling after DALK. Therefore, this procedure could prevent from Descemet membrane wrinkling in such cases.
authors.forename: Hamid
authors.initials: H
authors.lastname: Khakshoor
authors.affiliation: Vitreo-Retinal Research Center, Khatam-Al-Anbia Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Eslampoor
authors.forename: Saeed Shokoohi
authors.initials: SS
authors.lastname: Rad
authors.forename: Amirhossein
authors.initials: A
authors.lastname: Vejdani
mesh_terms: D000328:Adult; D019781:Corneal Topography; D016039:Corneal Transplantation / Q000379:methods*; D003886:Descemet Membrane / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000473:pathology / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult