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Long-term results of deep anterior lamellar keratoplasty in patients with keratoconus

Poster Details

First Author: P.Fournié FRANCE

Co Author(s):    J. Arné   F. Malecaze           

Abstract Details



Purpose:

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.

Setting:

Service d’Ophtalmologie, Hôpital Purpan, Toulouse, France.

Methods:

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.

Results:

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.

Conclusions:

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.

Financial Disclosure:

NONE

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