Deep Anterior Lamellar Keratoplasty Using the Big-Bubble Technique in Keratoconus

INTRODUCTION: The aim of this study was to evaluate the visual outcomes and complications of deep anterior lamellar keratoplasty (DALK) performed using the big-bubble technique in patients with keratoconus.
METHODS: In this case series, 57 eyes of 57 patients with moderate to advanced keratoconus underwent DALK. All of the participants were contact lens-intolerant or had an unacceptable contact lens fitting as a result of advanced keratoconus. DALK was performed using the big-bubble technique. Full thickness donor corneas devoid of Descemet’s membrane were sutured to the recipient bed. Preoperative and postoperative best spectacle-corrected visual acuity (BSCVA), corneal topography, and intra-postoperative complications were evaluated.
RESULTS: The mean age of 40 male (70%) and 17 female (30%) patients who had an average follow-up of 48.84±18.12 months (range: 12–60 months) in this study was 28±11.3 years (range: 7–63 years) at the time of the DALK procedure. The mean BSCVA increased from 1.41±0.44 logMAR to 0.87±0.37 logMAR at the final follow-up (p<0.001). The mean preoperative value of flat (K1) and steep (K2) curvature power was 53.5±8.8 diopters (D) and 60.6 ± 8.5 D, respectively, while the postoperative mean K1 and K2 value was 42.8±1.2 D and 46.06±1.3 D. Microperforation was seen in 6 patients (10.5%) during the suturation as an intraoperative complication. Postoperatively, 8 patients (14%) underwent suture revision and 1 patient (0.2%) underwent amniotic membrane transplantation.
DISCUSSION AND CONCLUSION: DALK using the big-bubble technique appears to be a safe and effective procedure in patients with keratoconus.