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. 2016 Jan-Mar;11(1):32-6.
doi: 10.4103/2008-322X.180711.

Visual Outcomes of Successful versus Failed Big-Bubble Deep Anterior Lamellar Keratoplasty for Keratoconus

Mohammad Ali Javadi  1 , Hossein Mohammad-Rabei  1 , Sepehr Feizi  2 , Seyed-Hashem Daryabari  3
Affiliations

Visual Outcomes of Successful versus Failed Big-Bubble Deep Anterior Lamellar Keratoplasty for Keratoconus

Mohammad Ali Javadi et al. J Ophthalmic Vis Res. 2016 Jan-Mar.

Abstract

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.

Keywords: Big-Bubble Technique; Deep Anterior Lamellar Keratoplasty; Keratoconus; Success Rate; Visual Acuity.

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Figures

Figure 1
Figure 1
Changes in postoperative best spectacle-corrected visual acuity (BSCVA) over the follow-up period in each group at months 1 (P= 0.03), 3 (P< 0.001), 6 (P< 0.001), 12 (P< 0.001), 18 (P< 0.001), and years 2 (P= 0.002), 3 (P= 0.001), 4 (P= 0.007), 5 (P= 0.02), and 6 (P= 0.03).
See this image and copyright information in PMC

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