Long-term results of deep anterior lamellar keratoplasty for the treatment of keratoconus.

To evaluate the long-term endothelial cell density (ECD) changes and visual and refractive outcomes after deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in eyes with keratoconus.
Retrospective interventional case series study.
setting: Single hospital. patients: Two hundred forty-one eyes of 214 patients who underwent DALK for moderate to advanced keratoconus. main outcome measures: Intraoperative and postoperative complications, postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), spherical equivalent refraction, topographic astigmatism, and ECD.
Two hundred thirty-four procedures (97%) were completed as DALK. Big bubble was successfully achieved in 193 eyes (82.4%). In 7 eyes (3%), the procedure was converted to penetrating keratoplasty because of Descemet membrane macroperforations. Microperforations occurred in 18 eyes (7.5%). The mean follow-up time was 50.5 ± 22.2 months (range 24 to 96 months). UCVA was lower than 20/100 in all eyes preoperatively and better than 20/100 in 191 eyes (81.6%) postoperatively. BSCVA was 20/40 or better in 187 eyes (79.9%) and 20/20 or better in 38 eyes (16.2%). The mean (± SD) preoperative ECD that was possible in 166 eyes was 2797 ± 561 cells/mm(2). Mean (± SD) endothelial cell loss was 8.1% ± 4.6% at 1 year, 10.5% ± 5.7% at 2 years, 15.1% ± 14.8% at 6 years, and 22.5% ± 15.9% at 8 years. Stromal graft rejection episodes occurred in 4 eyes, which resolved with appropriate therapy.
Deep anterior lamellar keratoplasty that uses the big-bubble technique is effective in patients with keratoconus. Long-term endothelial cell loss was moderate and lower than penetrating keratoplasty grafts.
AuthorsAnil Kubaloglu, Esin Sögütlü Sari, Mustafa Unal, Arif Koytak, Ekrem Kurnaz, Yasin Cinar, Yusuf Ozertürk
JournalAmerican journal of ophthalmology (Am J Ophthalmol) Vol. 151 Issue 5 Pg. 760-767.e1 (May 2011) ISSN: 1879-1891 [Electronic] United States
PMID21333267 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2011 Elsevier Inc. All rights reserved.
  • Adolescent
  • Adult
  • Astigmatism (physiopathology)
  • Cell Count
  • Child
  • Corneal Endothelial Cell Loss (physiopathology)
  • Corneal Transplantation
  • Endothelium, Corneal (pathology)
  • Female
  • Follow-Up Studies
  • Humans
  • Intraoperative Complications
  • Keratoconus (physiopathology, surgery)
  • Male
  • Middle Aged
  • Postoperative Complications
  • Refraction, Ocular (physiology)
  • Retrospective Studies
  • Treatment Outcome
  • Visual Acuity (physiology)

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