Large-Diameter Modified Big Bubble Deep Anterior Lamellar Keratoplasty For Ectasia After Keratorefractive Surgery
Published 2023 - 41st Congress of the ESCRS
Reference: FP06.02 | Type: Free paper | DOI: 10.82333/01s3-cv02
Authors: Luca Furiosi* 1 , Rossella Spena 1 , Marco Pellegrini 1 , Angeli Christy Yu 1 , Cristina Bovone 1 , Massimo Busin 1
1Department of Translational Medicine,University of Ferrara,Ferrara,Italy;Department of Ophthalmology,Ospedali Privati Forlì,“Villa Igea”,Forlì,Italy
Purpose
To report the outcomes of our large-diameter (9 mm) modified big-bubble deep anterior lamellar keratoplasty (DALK) for ectasia after keratorefractive surgery
Setting
Ospedali Privati Forlì, "Villa Igea", Forlì, Italy.
Methods
Modified big-bubble DALK was attempted in 12 consecutive eyes with ectasia following LASIK (n=4) and PRK (n=8). The surgery involved deep trephination based on the anterior segment optical coherence tomography pachymetry measurement at 9 mm diameter, pneumatic dissection from the base of the trephination, and limited stromal clearance of the optical zone (6 mm). Outcome measures were success rate of pneumatic dissection, best spectacle corrected visual acuity (BSCVA), refractive astigmatism and postoperative complication rates.
Results
DALK was successfully performed in all 12 eyes. Pneumatic dissection with type 1 big bubble succeeded in 10 cases (83.5%). The 2 other cases were completed by layer-by- layer manual dissection. Baseline BSCVA significantly improved from 0.99 ± 0.52 to 0.14 ± 0.13 logMAR (P <.001). All eyes reached Snellen CDVA ≥ 20/40, while 6 eyes (50%) reached ≥ 20/25. At last follow-up, 10 eyes (83%) had a refractive astigmatism ≤4 D. Stromal rejection or graft failure was not observed over a mean follow-up of 5 ± 3 years.
Conclusions
In eyes with ectasia following keratorefractive surgery, large 9.0-mm DALK can provide superior visual outcomes and significantly lower degrees of astigmatism without an increased risk of immune rejection and graft failure.