Deep Anterior Lamellar Keratoplasty Using the Big-bubble Technique

To review the visual outcome and complications of deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in patients with corneal ectasia 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. 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%). 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.