Descemet-on Versus Descemet-off Donor Cornea for Deep Anterior Lamellar Keratoplasty

To determine the effect of retained donor Descemet membranes (DMs) on visual outcomes following deep anterior lamellar keratoplasty (DALK). In this retrospective comparative study, keratoconic eyes undergoing DALK using the big-bubble technique were enrolled. A bared DM was achieved in all cases. A donor cornea without (group 1; 48 eyes) or with (group 2; 22 eyes) DM was sutured to the recipient bed. The 2 groups were compared in terms of best spectacle-corrected visual acuity, keratometric astigmatism, refractive error, contrast sensitivity (CS), higherorder aberrations (HOAs), and central graft thickness at least 3 months after complete suture removal. The mean follow-up duration was 23.2±6.9 months in group 1 and 26.5±6.5 months in group 2 (P = 0.61). The postoperative best spectacle-corrected visual acuity was 0.18±0.08 logMAR and 0.24±0.30 logMAR, respectively (P = 0.36). The 2 groups had comparable postoperative keratometric astigmatism, spherical equivalent refraction, and HOAs. In terms of CS, however, group 1 demonstrated better results at a low spatial frequency. The mean postoperative central graft thickness was greater in group 2 (589.8±34.5 mm) than in group 1 (523.6±63.0 mm; P< 0.001). DALK using the big-bubble technique for keratoconus may give better results in terms of CS if a donor cornea without DM is transplanted.