Large-Diameter Modified Big-Bubble Deep Anterior Lamellar Keratoplasty in Post-Radial Keratotomy Eyes

PURPOSE: To report the outcomes of our modified large-diameter (9-mm) big-bubble deep anterior lamellar keratoplasty (DALK) technique with improved success rates of pneumatic dissection in post-radial keratotomy (RK) eyes. DESIGN: Retrospective case series. METHODS: At Ospedali Privati Forli, "Villa Igea," Forli, Italy., modified big-bubble DALK was performed in consecutive post-RK eyes. The technique included large-diameter (9-mm) deep partial-thickness trephination based on the thinnest anterior segment optical coherence tomography pachymetry value at 9 mm, air injection through a cannula advanced 2 mm centripetally from the base of the trephination, limited stromal clearance of the central 6-mm optical zone, and suturing of a 9-mm anterior lamellar graft prepared by microkeratome dissection. Success rate of pneumatic dissection, corrected distance visual acuity (CDVA), keratometric astigmatism, and complications were recorded. RESULTS: Eight eyes of 7 patients were included. Pneumatic dissection succeeded in 7 cases (87.5%). CDVA significantly improved from 0.94 +/- 0.43 to 0.14 +/- 0.06 logMAR (P <.001). All eyes reached Snellen CDVA >= 20/40, whereas 3 eyes (37.5%) reached >= 20/25. At the last follow-up, 5 eyes (62.5%) had a final keratometric astigmatism <= 4 diopters, whereas 2 eyes (25.0%) had <= 2 diopters. CONCLUSION: Big-bubble DALK can be successfully performed in post-RK eyes with our standardized technique. (c) 2022 Elsevier Inc. All rights reserved.