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Big bubble deep lamellar keratoplasty in anterior corneal diseases: a Pakistani perspective

Poster Details

First Author: K.Mahmood PAKISTAN

Co Author(s):                        

Abstract Details


Big bubble technique of DALK in becoming very favorable around the world and the trend is shifting from PK to this technique. In developing nations the PKP is still the choice and widely done procedure even in the diseases involving the anterior or mid corneal stroma. From manual baring to big bubble the learning curve is demanding and challenging. In Pakistan we have very few centers where this technique is being practiced. The main issue is the lack of resources and training programs. In this study, I am presenting my experience of DALK in cases of Keratoconus and corneal dystrophies.


The study was conducted at Aadil Hospital and Avicenna Medical College and Hospital, Lahore Pakistan


120 eyes from 101 patients were operated from Jan 2015 to Dec 2016. The age group was between 19 y to 36 years. The 81 eyes were having advanced KC, 12 eyes Granular and 08 eyes with macular corneal dystrophy. Out of 81 eyes with KC, 21 had CXL treatment in the past 3 years. After trephination upto 80% of stromal depth and stromal debulking , the big bubble was injected using the Fontana air cannula. DM baring was then carried out. Endothelium was removed and donor tissue was anchored with 16 interrupted 10/0 nylon sutures in all cases.


The big bubble was achieved in 87% of the cases. Perforation was the major complication. In 2 eyes perforation occurred during slashing, in 9 when baring the DM and in 1 eye during suturing. 6 eyes converted to PKP due to macro-perforation. In 114 eyes underwent successful DALK , BCVA of 6/6 was achieved in 35, 6/9-6/12 in 61, 6/18 in 18 eyes. The post-op refractive error ranged from �.0DS to �â�€�“ 3.87DS. The average cylinder correction was �â�€�“ 2.65 DC. Interface haze was observed in 5 eyes, heame in 1 eye and traction fold of cornea in 3 eyes.


Big bubble DALK techniques is a very safer method of corneal transplant in the corneal diseases affecting even the deeper stroma. The main advantage is the preservation of host endothelium which limits the episode of graft failure. The donor tissue is widely available as we don�â�€�™t need healthy endothelial cell count. The visual acuity compared was remarkable with a moderate refractive error after manipulating/removal of sutures at final follow-up. The learning curve is longer that reserves and limits the technique. Only major complication was perforation at different sites and stages which can be overcome by experience.

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