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ORIGINAL ARTICLE
Year : 2016  |  Volume : 11  |  Issue : 1  |  Page : 32-36

Visual outcomes of successful versus failed big-bubble deep anterior lamellar keratoplasty for keratoconus


1 Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of Ophthalmology, Baqiyatallah University of Medical Sciences, Tehran, Iran

Correspondence Address:
Mohammad Ali Javadi
Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, No. 23, Paidarfard St., Boostan 9 St., Pasdaran Ave., Tehran 16666
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2008-322X.180711

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Purpose: To compare the visual outcomes of deep anterior lamellar keratoplasty (DALK) for keratoconus with and without successful big-bubble formation. Methods: In this retrospective comparative study, a total of 289 consecutive eyes from 257 patients underwent DALK using the big-bubble technique. In cases where the big bubble could not be accomplished, manual stromal dissection down to Descemeton membrane (DM) was performed using a crescent knife. Visual acuity and refractive outcomes were compared between the bare DM group (Group 1) and manual dissection group (Group 2). Results: A bare DM was successfully achieved in 229 (79.2%) eyes and manual dissection was performed in 60 (20.8%) eyes. The study groups were comparable in terms of age (P = 0.79), preoperative best-spectacle corrected visual acuity (BSCVA) (P = 0.15), and follow-up duration (P = 0.73). Postoperative BSCVA was significantly better in Group 1 than in Group 2 throughout follow-up (P < 0.05). In Group 2, BSCVA was significantly lower in eyes with advanced keratoconus as compared to those with moderate keratoconus (P = 0.007). At final follow-up, BSCVA ≤ 0.30 logarithm of minimum angle of resolution (logMAR) was achieved in 82.1% of eyes in Group 1 versus 54.5% of eyes in Group 2 (P < 0.001). Groups 1 and 2 were comparable in terms of postoperative spherical equivalent refractive error (P = 0.61) and keratometric astigmatism (P = 0.39). Conclusion: Retention of the posterior corneal stroma which occurs with manual dissection during failed big bubble formation in DALK is associated with lower visual acuity as compared to achieving a bare DM.


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