Comparison of Descemet-On Versus Descemet-Off Deep Anterior Lamellar Keratoplasty in Keratoconus Patients: A Randomized Trial.
OBJECTIVE
To compare the visual outcomes of Descemet membrane (DM)-on and DM-off after deep anterior lamellar keratoplasty (DALK) using the big-bubble (BB) technique in keratoconus patients.


METHODS
In this prospective trial, keratoconic eyes undergoing DALK procedures with the BB technique were randomized into 2 groups: a donor cornea without DM (group 1; 29 eyes) or with DM (group 2; 30 eyes). These groups were compared with respect to best-corrected visual acuity and contrast sensitivity while wearing gas permeable contact lenses and also endothelial cell counts.


RESULTS
There were no statistically significant differences between the 2 groups with regard to best-corrected visual acuity and contrast sensitivity using gas permeable contact lenses as well as endothelial cell counts at 3, 6, and 12 months. After 1 year, the mean (±SD) postoperative visual acuity CL (with contact lenses) was 0.05 (±0.01) in the DM-off group and 0.05 (±0.01) in the DM-on group (P = 0.956). Mean postoperative endothelial cell counts were 2425.0 (±123.7) and 2306.7 (79.9), respectively (P = 0.443), and corneal thicknesses were 527.9 (58.3) and 556.6 (47.3), respectively (P = 0.150). During the follow-up period, very few complications occurred and neither group had a predominance of adverse events at 3, 6, 12, or 24 months.


CONCLUSIONS
In conclusion, DALK procedures using the BB technique for keratoconus with DM-on or DM-off presented no significant differences regarding the visual outcomes or endothelial cell counts.
*Department of Ophthalmology, Federal University of São Paulo, Sao Paulo, Brazil; and †Department of Ophthalmology, Sorocaba Eye Hospital, Sorocaba, Brazil.
Tatiana M B
TM
Prazeres
Rodrigo T
RT
Muller
Tatiana
T
Rayes
Flávio E
FE
Hirai
Luciene B
LB
de Sousa
D000328:Adult; D002452:Cell Count; D015350:Contrast Sensitivity / Q000502:physiology; D016039:Corneal Transplantation / Q000379:methods*; D003886:Descemet Membrane / Q000601:surgery*; D004311:Double-Blind Method; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D013048:Specimen Handling; D014019:Tissue Donors; D014792:Visual Acuity / Q000502:physiology*