title: Big bubble deep anterior lamellar keratoplasty for management of deep fungal keratitis.
abstract: Objective. To evaluate the therapeutic effect of big bubble deep anterior lamellar keratoplasty (DALK) in patients with deep fungal keratitis. Methods.Consecutive patients who had DALK for deep fungal keratitis at Shandong Eye Hospital between July 2011 and December 2012 were included. In all patients, the infiltration depth was more than 4/5ths of the corneal thickness. DALK surgery was performed with bare Descemet membrane (DM) using the big bubble technique. Corrected distance visual acuity (CDVA), graft status, and intraoperative and postoperative complications were monitored. Results. Big bubble DALK was performed in 23 patients (23 eyes). Intraoperative perforation of the DM occurred in two eyes (8.7%) during stromal dissection. The patients received lamellar keratoplasty with an air bubble injected into the anterior chamber. Double anterior chamber formed in 3 eyes (13.0%). Mean CDVA of the patients without cataract, amblyopia, and fungal recurrence was improved from preoperative HM/20 cm-1.0 (LogMAR) to 0.23 ± 0.13 (LogMAR) at the last followup (P < 0.01). Fungal recurrence was found in two patients (8.7%). Corneal stromal graft rejection was noted in one patient (4.3%). Conclusions. DALK using the big bubble technique seems to be effective and safe in the treatment of deep fungal keratitis unresponsive to medication.
authors.affiliation: Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, 372 Jingsi Road, Jinan 250021, China ; Bascom Palmer Eye Institute, University of Miami, 1638 NW 10th Avenue, Miami, FL 33136, USA.
authors.forename: Hua
authors.initials: H
authors.lastname: Gao
authors.affiliation: Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, 372 Jingsi Road, Jinan 250021, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Song
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, 1638 NW 10th Avenue, Miami, FL 33136, USA.
authors.forename: Jose J
authors.initials: JJ
authors.lastname: Echegaray
authors.affiliation: Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, 372 Jingsi Road, Jinan 250021, China.
authors.forename: Yanni
authors.initials: Y
authors.lastname: Jia
authors.affiliation: Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, 372 Jingsi Road, Jinan 250021, China.
authors.forename: Suxia
authors.initials: S
authors.lastname: Li
authors.affiliation: Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, 372 Jingsi Road, Jinan 250021, China.
authors.forename: Man
authors.initials: M
authors.lastname: Du
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, 1638 NW 10th Avenue, Miami, FL 33136, USA.
authors.forename: Victor L
authors.initials: VL
authors.lastname: Perez
authors.affiliation: Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, 372 Jingsi Road, Jinan 250021, China ; Shandong Eye Institute, 5 Yanerdao Road, Qingdao 266071, China.
authors.forename: Weiyun
authors.initials: W
authors.lastname: Shi
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