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First Author: P.Fournié FRANCE
Co Author(s): J. Arné F. Malecaze
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Long-term endothelial cell density changes and visual and refractive outcomes after descemetic (d) and predescemetic (pd) deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in eyes with keratoconus.
Service dOphtalmologie, Hôpital Purpan, Toulouse, France.
Retrospective, consecutive, non-comparative, case series analysis of 95 eyes that have undergone DALK for keratoconus using the big-bubble technique with at least 1 year of follow-up. Big-bubble was achieved in 74 (77.9%) eyes (dDALK), whereas 21 (22.1%) eyes underwent manual lamellar dissection (pdDALK) because of failed big-bubble. Intra- and post-operative complications, visual acuity, spherical equivalent refraction, keratometric and topographic astigmatism, ultrasound pachymetry, specular microscopy, and optical coherence tomography (OCT) findings were recorded.
Descemet ruptures occurred in 13 of 95 cases (13.7%). Five ruptures (5.3%) were converted to penetrating keratoplasty. Mean length of follow-up was 5.3 years (range, 1-8 years). Postoperative best spectacle-corrected visual acuity was significantly better in dDALK group than in pdDALK group at years 1 and 2. But, at the final examinations, there was no significant difference between the study groups (0.25 ±0.22 logarithm of the minimum angle of resolution in dDALK group and 0.33 ±0.15 logarithm of the minimum angle of resolution in pdDALK group; p = 0.12). The 2 groups were comparable regarding astigmatism and spherical equivalent refractive error throughout the follow-up period. Mean endothelial cell loss was 22.5 ±17.9% at last follow-up with most of the loss occurring in the first year (8.7% ±5.6%). Stromal graft rejection episodes occurred in 3 eyes (3.2%), which resolved with appropriate therapy.
DALK using the big-bubble technique is effective in patients with keratoconus. In DALK, manual lamellar dissection is a reasonable alternative when big-bubble separation of the Descemet membrane is not achieved.