title: Femtosecond laser-assisted deep anterior lamellar keratoplasty with big-bubble technique for keratoconus.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the clinical results after deep anterior lamellar keratoplasty (DALK) assisted by the femtosecond laser with big-bubble technique for keratoconus.
  
  
  METHODS
  A case series of 22 eyes in 19 patients with keratoconus was enrolled in the study. The 500-kHz VisuMax femtosecond laser (Carl Zeiss Meditec AG, Jena, Germany) was used to create a vertical side cut on donor and recipient corneas. Intraoperative and postoperative complications, uncorrected visual acuity, best-corrected visual acuity, corneal curvature, and central corneal thickness were evaluated in all patients.
  
  
  RESULTS
  Big-bubble and naked Descemet's membrane (DM) were successfully achieved in twenty eyes (90.9%). Intraoperative macroperforation of DM occurred in two cases and converted to full-thickness keratoplasty. The mean follow-up time was 18.8 ± 5.3 months. The best-corrected visual acuity was increased from 0.3 to 1.0, mean corneal curvature was 43.0 ± 2.3D, and mean central corneal thickness was 508.9 ± 60.1 μm (range, from 430 to 600 μm) postoperatively.
  
  
  CONCLUSIONS
  Our results indicate that femtosecond laser-assisted DALK with big-bubble technique is an accurate, safe, and effective method to treat the patients with keratoconus.
authors.affiliation: Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University; Department of Endocrinology, Geriatric Research Center, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China.
authors.forename: Xiangfei
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China.
authors.forename: Liping
authors.initials: L
authors.lastname: Yang
authors.affiliation: Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China.
authors.forename: Chunyan
authors.initials: C
authors.lastname: Xue
authors.affiliation: Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China.
authors.forename: Zhenping
authors.initials: Z
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D063171:Corneal Pachymetry; D003319:Corneal Stroma / Q000503:physiopathology / Q000601:surgery*; D048988:Corneal Surgery, Laser / Q000379:methods*; D019781:Corneal Topography; D016039:Corneal Transplantation / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007640:Keratoconus / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications; D014019:Tissue Donors; D066027:Transplant Recipients; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult