Outcomes of deep anterior lamellar keratoplasty using the big-bubble technique in various corneal diseases.

PURPOSE: To report clinical outcomes of deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in various original diagnoses.

DESIGN: Prospective interventional study.

METHODS: Single hospital study of 115 unselected consecutive patients (131 eyes) with various diagnoses undergoing DALK using the big-bubble technique. The main outcome measures were intraoperative and postoperative complications, postoperative best spectacle-corrected visual acuity (BSCVA), and endothelial cell density (ECD).

RESULTS: Descemet membrane was exposed successfully in 25 eyes (80.6%) with advanced keratoconus, 11 (73.3%) with chemical or thermal burns, 20 (71.4%) with corneal dystrophy, 21 (70%) with a herpes simplex (HSK) keratitis scar, 4 (36.4%) with moderate keratoconus, and 5 (31.3%) with a bacterial keratitis scar (P < .05). Loosening of the sutures occurred in 24 eyes (23.8%) between postoperative4 and 7 months. Epithelial rejection was observed in 2 eyes and stromal rejection occurred in 5 eyes. BSCVA was improved in HSK scarring and corneal dystrophy vs keratoconus and corneal burns at 1 year (P < .05), but not after a mean follow-up of 21.4 months (P < .05). Patients who experienced stromal rejection had lower ECD than patients with no rejection at 18 and 24 months (P < .05). At all follow-up times after 6 months, patients with multiple air injection attempts had lower ECD than patients with 1 injection attempt (P < .05).

CONCLUSIONS: Different Descemet membrane exposure rates were observed in different diagnoses using the big-bubble technique. Both severe stromal rejection and additional manipulation may have a deleterious effect on the corneal endothelium.