Deep Anterior Lamellar Keratoplasty Using Big-Bubble Technique for Treatment of Corneal Stromal Scars

Purpose: To report the clinical outcomes of deep anterior lamellar keratoplasty (DALK) in patients with anterior corneal stromal scars associated with various etiologies. Methods: A total of 79 eyes of 79 patients with corneal stromal scars sparing the Descemet membrane and the endothelium underwent DALK by using big-bubble technique. The main outcome measures of the study were the ability to successfully complete DALK, intraoperative and postoperative complications, best spectacle-corrected visual acuity, refraction, and graft clarity. Results: Seventy-two of the surgical procedures were carried out as DALK, and the mean follow-up time was 28.1 +/- 17.9 months (range, 12-78 months). The most frequent indication for DALK surgery was postherpetic keratitis (44%). Complete Descemet membrane exposure via big bubble (descemetic DALK) could be achieved in 57 cases (79%). Fifteen eyes (21%) required layer-by-layer manual dissection (predescemetic DALK). Best spectacle-corrected visual acuity of 6/12 or better was present in 59 eyes (82%) postoperatively. The mean spherical equivalent and topographic astigmatism were -3.32 +/- 2.13 (range, -9.13 to +4.75) and -2.97 +/- 1.94 (range, -8.0 to +4.50) diopter, respectively. There were 2 instances of stromal graft rejection, which responded to medical therapy. Conclusions: DALK big-bubble technique may be a valuable and safe treatment in patients with corneal stromal scar with healthy endothelium. The visual and refractive outcomes are comparable to standard penetrating keratoplasty, avoiding the risk of endothelial rejection.