Results of Deep Lamellar Keratoplasty Using the Big-bubble Technique in Patients With Keratoconus

doi:10.1016/j.ajo.2005.08.064

American Journal of Ophthalmology

Volume 141, Issue 2, February 2006, Pages 254-259.e1

https://doi.org/10.1016/j.ajo.2005.08.064 Get rights and content

Purpose

To evaluate the efficacy of deep lamellar keratoplasty using the big-bubble technique in patients with keratoconus.

Design

Interventional case series.

Methods

Thirteen eyes of 12 patients (eight male and four female subjects) with moderate to advanced keratoconus and intolerance to contact lens wear were included in this study. Deep lamellar keratoplasty was performed by the intrastromal air injection technique. Full-thickness donor tissue devoid of Descemet membrane and endothelium was then sutured into place. Best-corrected visual acuity, refractive results, surgical technique, and complication rates were analyzed.

Results

Big bubble was successfully achieved in nine eyes (69.2%). Average postoperative best-corrected visual acuity was 20/25 (range 20/50 to 20/20) at a mean follow-up of 5 months. Intraoperative microperforation of Descemet membrane occurred in two eyes (15.3%). Three eyes (23%) developed a steroid-induced increase in intraocular pressure, which responded to medical therapy.

Conclusions

Deep lamellar keratoplasty that uses the big-bubble technique is safe and effective in patients with keratoconus. Visual outcome is comparable to standard penetrating keratoplasty, without the risk of endothelial rejection.

Section snippets

Methods

The study was approved by the Institutional Review Board, and informed consent was obtained from all participants. Thirteen eyes of 12 patients with moderate to advanced keratoconus and intolerance to contact lens wear underwent a DLK procedure using the big-bubble technique. Patients with scarring of DM were excluded. Mean age was 24.5 ± 8.0 years (range, 14–41 years). There were eight male and four female subjects. All patients had complete ophthalmic examination before surgery including

Results

The average preoperative best-corrected visual acuity was 20/200 (range counting fingers to 20/100). Preoperative mean keratometry was 49.8 ± 5.98 diopters, and astigmatism was 6.1 ± 3.2 diopters (range, 1.72–12 diopters). Average central corneal pachymetry was 365 ± 68.4 μm (range, 275–482 μm). No clear image of the endothelium could be obtained on specular microscopy in 10 eyes because of advanced keratoconus.

With a host-donor disparity of 0.5 mm, a 8.5 mm–9.0 mm trephine combination was used

Discussion

Lamellar keratoplasty for keratoconus was first discussed by Enrique Malbran in 1964.⁸ Air injection technique was first proposed by Archila,⁶ later used by Price,⁹ Chau and coauthors,¹⁰ and Morris and coauthors.¹¹ However, none of them was able to consistently achieve cleaving of the DM from the stroma after air injection. Anwar and Teichmann⁷ then described the big-bubble technique to consistently achieve separation of the DM from stroma after intrastromal air injection. In our series, we

Rajesh Fogla, DNB, FRCS

MBBS, Gauhati Medical College - Assam, India - 1991

Diplomate of the National Board of Examinations (DNB, Ophthalmology), New Delhi, India - 1997

Cornea Fellowship - Medical Research Foundation, Chennai, India - 1997 - 1998

Fellow of the Royal College of Surgeons (FRCS, Edinburgh) - 1998

Master of Medicine (Ophthalmology) MMed, National University of Singapore - 1998

Consultant Ophthalmologist - Sankara Nethralaya, Chennai, India - 1998 - April 2005

Senior Consultant

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Citation Excerpt :
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Rajesh Fogla, DNB, FRCS

MBBS, Gauhati Medical College - Assam, India - 1991

Diplomate of the National Board of Examinations (DNB, Ophthalmology), New Delhi, India - 1997

Cornea Fellowship - Medical Research Foundation, Chennai, India - 1997 - 1998

Fellow of the Royal College of Surgeons (FRCS, Edinburgh) - 1998

Master of Medicine (Ophthalmology) MMed, National University of Singapore - 1998

Consultant Ophthalmologist - Sankara Nethralaya, Chennai, India - 1998 - April 2005

Senior Consultant Ophthalmologist - Apollo Hospitals, Hyderabad, India May 2005 & continuing

Anterior segment surgeon

Areas of specialization - Cornea & External Diseases, Lamellar corneal surgery, Ocular Surface Reconstruction, and Refractive Surgery

: Supported in part by the Vision Research Foundation, Chennai, India.

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Original articleResults of Deep Lamellar Keratoplasty Using the Big-bubble Technique in Patients With Keratoconus

Purpose

Design

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Ophthalmology

Ophthalmology

Am J Ophthalmol

J Cataract Refract Surg

Am J Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Original article
Results of Deep Lamellar Keratoplasty Using the Big-bubble Technique in Patients With Keratoconus