title: Descemetic and predescemetic DALK in keratoconus patients: a clinical and confocal perspective study.
abstract: OBJECTIVE
  To evaluate the clinical outcomes and in vivo confocal microscopy (IVCM) features of keratoconus patients who underwent deep anterior lamellar keratoplasty (DALK).
  
  
  METHODS
  DALK was performed using the big bubble technique in all the patients. If the bubble was not successful to bare the descemet membrane, a manual dissection layer-by layer was performed to expose a deep stromal plane close to the DM. The patients were divided in two groups depending on the intraoperative baring of the descemet membrane: predescemetic DALK (PD-DALK) and descemetic DALK (D-DALK) group.
  
  
  RESULTS
  One month after surgery the D-DALK patients show an increase of mean BCVA. In the PD-DALK group mean BCVA did not show significant improvement as compared to preoperative values. At 6 months after surgery mean BCVA was found to be similar in both groups. At 1 month IVCM the peak of reflectivity of the interface was lower in D-DALK group compared to PD-DALK. At 6 months the values of reflectivity were comparable.
  
  
  CONCLUSIONS
  At 1 month D-DALK seems to lead to a minor interface reflectivity and to a better BCVA; these differences disappear after 6 months and the values of interface reflectivity and BCVA are comparable between D-DALK and PD-DALK.
authors.affiliation: IRCCS Bietti Foundation, Via Livenza 3, 00198 Rome, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Schiano-Lomoriello
authors.affiliation: Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy.
authors.forename: Rossella Annamaria
authors.initials: RA
authors.lastname: Colabelli-Gisoldi
authors.affiliation: Universita degli Studi "Gabriele D'Annunzio", Chieti, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Nubile
authors.affiliation: IRCCS Bietti Foundation, Via Livenza 3, 00198 Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Oddone
authors.affiliation: IRCCS Bietti Foundation, Via Livenza 3, 00198 Rome, Italy.
authors.forename: Giorgio
authors.identifier: 0000-0003-3257-4503
authors.initials: G
authors.lastname: Ducoli
authors.affiliation: Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy.
authors.forename: Carlo Maria
authors.initials: CM
authors.lastname: Villani
authors.affiliation: Universita degli Studi "Gabriele D'Annunzio", Chieti, Italy.
authors.forename: Leonardo
authors.identifier: 0000-0003-4890-3834
authors.initials: L
authors.lastname: Mastropasqua
authors.affiliation: Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy.
authors.forename: Augusto
authors.initials: A
authors.lastname: Pocobelli
mesh_terms: D016039:Corneal Transplantation; D003886:Descemet Membrane / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007640:Keratoconus / Q000473:pathology / Q000601:surgery*; D018613:Microscopy, Confocal; D014792:Visual Acuity