Deep Anterior Lamellar Keratoplasty Using the Big-Bubble Technique in Keratoconus

To evaluate the visual outcomes and complications of deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in patients with keratoconus. In this case series, 104 eyes of 99 patients with moderate to advanced keratoconus underwent DALK. All subjects were contact lens intolerant or had unacceptable spectacle-corrected visual acuity. DALK was performed using the big-bubble technique. Full thickness donor corneas devoid of Descemet''s membrane (DM) were sutured to the recipient bed. Best spectacle-corrected visual acuity (BSCVA), refractive status, and intra- and postoperative complications were evaluated. Patients were male in 62.5%. Mean age of patients was 26.2±7.79 (range 15-46) years at the time of DALK and were followed for 23.07±8.1 (range 9-42) months. Mean BSCVA increased from 1.23±0.4 logMAR to 0.26±0.2 logMAR at final follow-up (P < 0.001). Postoperative mean spherical equivalent refractive error and refractive and keratometric astigmatism were -3.41±3.1 D, 3.07±2.4 D, and 3.64±2.2 D, respectively. Bared DM was achieved in 86 (82.7%) eyes. Main complications encountered included filamentary keratitis (19.2%), non-endothelial graft rejection (14.4%), and suture abscess (10.6%). DALK using the big-bubble technique appears to be a safe and effective procedure in patients with keratoconus.