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Modified big‐bubble technique compared to manual dissection deep anterior lamellar keratoplasty in the treatment of keratoconus
Author(s) -
Knutsson Karl Anders,
Rama Paolo,
Pagai Giorgio
Publication year - 2015
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.12705
Subject(s) - keratoconus , medicine , visual acuity , ophthalmology , bubble , dissection (medical) , stromal cell , surgery , cornea , computer science , parallel computing
Abstract Purpose To evaluate the clinical findings and results of manual dissection deep anterior lamellar keratoplasty ( DALK ) compared to a modified big‐bubble DALK technique in eyes affected by keratoconus. Methods Sixty eyes of 60 patients with keratoconus were treated with one of the two surgical techniques manual DALK ( n  = 30); big‐bubble DALK ( n  = 30). The main outcomes measured were visual acuity, corneal topographic parameters, thickness of residual stroma and endothelial cell density ( ECD ). Patients were examined postoperatively at 1 month, 6 months, 1 year and 1 month after suture removal. Results Final best spectacle‐corrected visual acuity ( BSCVA ) measured 1 month after suture removal was 0.11 ± 0.08 Log MAR in the big‐bubble group compared to 0.13 ± 0.08 in the manual DALK group (p = 0.227). In patients treated with the big‐bubble technique without complications (Descemet's membrane completely bared), the stromal residue was not measureable. Mean stromal residual thickness in the manual DALK group was 30.50 ± 27.60  μ m. Data analysis of the manual DALK group demonstrated a significant correlation between BSCVA and residual stromal thickness; lower residual stromal thickness correlated with better BSCVA values (Spearman ρ  = 0.509, p = 0.018). Postoperative ECD was similar in both groups at all intervals, with no statistically significant differences. In both groups, ECD loss was only significant during the 1‐ to 6‐month interval (p = 0.001 and p < 0.001 in the big‐bubble DALK and manual DALK groups, respectively). Conclusion Manual DALK provides comparable results to big‐bubble DALK . Big‐bubble DALK permits faster visual recovery and is a surgical technique, which can be easily converted to manual DALK in cases of unsuccessful ‘big‐bubble’ formation.

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