Clinical Outcomes After Deep Anterior Lamellar Keratoplasty Using the Big-bubble Technique in Patients With Keratoconus  

Oleh:

Fontana, Luigi ; Parente, Gabriella ; Tassinari, Giorgio

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: American Journal of Ophthalmology (keterangan: ada di ClinicalKey) vol. 143 no. 01 (Jan. 2007), page 117.

Ketersediaan

Perpustakaan FK Nomor Panggil: A12.K.2007.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

Purpose To report clinical outcomes of deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in patients with keratoconus. Design Prospective noncomparative interventional study. Methods setting: Single hospital. patients: Eighty-one unselected consecutive patients with moderate to advanced keratoconus intolerant to contact lenses and with poor spectacle-corrected visual acuity. intervention: DALK big-bubble technique. main outcome measures: Intraoperative and postoperative complications, postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, corneal topography, and endothelial cell density. Results Seventy-eight procedures (96%) were completed as DALK. Big-bubble was achieved in 50 cases (64%); 28 (36%) required manual intrastromal dissection. Intraoperative microperforations occurred in 11 cases (13%). Baseline mean uncorrected visual acuity was 20/500 and 20/60 two years after surgery. Average preoperative BSCVA, was 20/100 and 20/30 at the end of follow-up. Final BSCVA was better in patients in whom big-bubble with exposure of the Descemet membrane was achieved (P < .05). Average keratometry and SD (standard deviation) refraction changed from 62.1 ± 6.7 diopters and -10.76 ± 5 diopters to 47.51 ± 4.73 diopters and -1.81 ± 3.2 diopters, respectively after surgery. Mean preoperative endothelial cell density was 2202.29 ± 392.35 cells/mm2 and 2034 ± 438.39 cells/mm2 two years after surgery. Two patients developed stromal rejection. Conclusions The DALK big-bubble technique is a valuable treatment in patients with keratoconus. Visual outcome is comparable to standard penetrating keratoplasty (PK) when formation of big-bubble with exposure of the Descemet membrane (DM) was achieved. Clinically important graft-host interface developed in some cases after manual intrastromal dissection. Stromal rejection is a rare complication.

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