Pentacam-based big bubble deep anterior lamellar keratoplasty in patients with keratoconus.

Abstract

PURPOSE:

To describe the clinical results of Pentacam-based big bubble deep anterior lamellar keratoplasty (DALK) to achieve an intended 90% depth of initial lamellar trephination.

METHODS:

Fifty consecutive eyes of 50 patients with keratoconus, keratoglobus, and anterior stromal scars were included. DALK was performed with the big bubble technique using a 90% intended depth for initial lamellar trephination based on preoperative pachymetry by Pentacam. Main outcome measures were success of surgery, best spectacle-corrected visual acuity, endothelial cell count, refractive astigmatism at 12-month follow-up, and rate of intra- and postoperative complications.

RESULTS:

In 84% of the patients (n = 42), Pentacam-based big bubble DALK could be performed successfully. Successful big bubble formation could be achieved in 80% of the patients (n = 34). In case of macroperforation (n = 8), surgery was converted to standard penetrating keratoplasty representing a conversion rate of 16%. Intraoperative microperforation (n = 5) could be handled by an intracameral air injection at the end of operation with successful completion of the lamellar procedure. No allograft rejection was observed. Best spectacle-corrected visual acuity improved from 20/125 ± 20/160 preoperatively to 20/40 ± 20/80 at 12-month follow-up. Endothelial cell count was 2102 ± 318 cells per square millimeter preoperatively and 1735 ± 420 cells per square millimeter at 12-month follow-up. Refractive astigmatism was 7.09 ± 3.13 diopters preoperatively and decreased to 4.13 ± 2.41 diopters.

CONCLUSION:

Pentacam-based big bubble DALK using a 90% intended depth of initial lamellar trephination seems to be a safe and effective procedure for anterior corneal stromal disorders such as keratoconus. We suggest that Pentacam-based depth assessment allows for reliably deep initial preparation and may allow more successful bubble formation in DALK surgery.

• Authors: Stephan Riss, Ludwig M Heindl, Bjoern O Bachmann, Friedrich E Kruse, Claus Cursiefen
• Journal: Cornea (Cornea) Vol. 31 Issue 6 Pg. 627-32 (Jun 2012) ISSN: 1536-4798 [Electronic] United States
• PMID: 22357390 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Astigmatism (physiopathology)
• Cell Count
• Corneal Topography
• Corneal Transplantation (methods)
• Endothelium, Corneal (pathology)
• Female
• Graft Survival (physiology)
• Humans
• Imaging, Three-Dimensional
• Keratoconus (physiopathology, surgery)
• Male
• Middle Aged
• Photography (methods)
• Retrospective Studies
• Treatment Outcome
• Visual Acuity (physiology)