Outcomes of Deep Anterior Lamellar Keratoplasty in Patients with

To evaluate visual outcomes after deep anterior lamellar keratoplasty (DALK) in patients with keratoconus.

In this interventional case series, patients with moderate to advanced keratoconus underwent DALK. Inclusion criteria consisted of contact lens intolerance or poor spectacle-corrected visual acuity.DALK was performed using the big-bubble technique introduced by Anwar and Teichmann. Outcome measures included visual acuity, refractive status, effect of different methods of suturing on visual outcomes and intraoperative and postoperative complications.

One-hundred and twenty-six consecutive eyes of 121 patients were included. At the time of surgery, mean patient age and mean follow-up period were 26.08±7.6 years and 21.62±9.0 months, respectively. Mean preoperative uncorrected and best corrected visual acuity were 20/500 and 20/400, increasing to 20/80 and 20/32 after the operation, respectively (P<0.001). Postoperatively mean spherical refractive error and refractive and keratometric astigmatism were -3.41±3.1 D, 3.04±2.3 D, and 3.67±2.1 D, respectively. Bared DM was achieved in 100 (81.3%) eyes, however, in 23 (18.7%) eyes a few layers of the stroma remained.

DALK using the big-bubble technique appears to be an effective procedure for patients with keratoconus. In the case of extensive intraoperative DM perforation or postoperative complications, PK could be done without any limitation.