Deep Anterior Lamellar Keratoplasty Using the Big-bubble Technique

Purpose : To review the visual outcome and complications of deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in patients with corneal ectasiaMethods : Eighteen consecutive patients with keratoconus or post-LASIK ectasia with poor spectacle-corrected visual acuity and/or contact lens intolerance were enrolled in this study between October 2005 and September 2006. DALK big-bubble technique was carried out in 17 eyes. In one eye, intraoperative conversion to penetrating keratoplasty (PKP) followed large Descemet s membrane perforation. Visual and refractive outcomes and intraoperative and postoperative complications were assessed.Results : Seventeen procedures (94%) were completed as DALK. The mean follow-up time was 9.5 months. At the last follow-up visit, mean best corrected visual acuity (BCVA) was 20/32 (0.20±0.14 LogMAR) and BCVA of 20/40 or better was achieved in 82% of the eyes. The mean postoperative topographic cylinder was 4.4±1.6 diopter (D), and the mean spherical equivalent was -3.3±6 D. Main postoperative complications included graft rejection (2/17, 12%), graft infection (1/17, 6%) and double anterior chamber (2/17, 12%).Conclusion : DALK is a valuable and successful alternative to PKP in patients with keratoconus. Graft rejection is a rare complication but is associated with good recovery because the endothelium is not involved