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Moramarco A, Gardini L, Di Mola I, di Geronimo N, Iannetta D, Romano V, Hannush SB, Fontana L. Big-bubble DALK: A technique in evolution. Ocul Surf 2024; 34:418-429. [PMID: 39369903 DOI: 10.1016/j.jtos.2024.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 09/29/2024] [Accepted: 10/01/2024] [Indexed: 10/08/2024]
Abstract
Deep anterior lamellar keratoplasty (DALK) is considered a valuablealternative to penetrating keratoplasty (PK) for treatingcorneal disordersthat do not involve theendothelium. DALK preserves the host endothelium, eliminating the risk of endothelial rejection and reducing the risk of late graft failure due to endothelial decay. Despite its not recent introduction, DALK has been considered a difficult, lengthy, and poorly reproducible procedure, limiting its adoption worldwide. With the introduction of the big-bubble technique (BBT) the reproducibility and the time required to complete the procedure were significantly improved, encouraging many surgeons to approach DALK. With BBT air is injected into the stroma to induce separation between the layers of the cornea, facilitating the separation of the diseased or scarred stroma from the healthy endothelium; this allows the creation of a graft-host interface of pristine optical quality, granting clinical results equal to those obtained with PK.Understanding the anatomy and physics behind the big bubble (BB) formation is crucial for thesurgical success of this technique. The discovery of the pre-Descemet's layer (Dua's layer)played a significant role in understanding the principles behindBBformation, considerablyimpacting the safety and reproducibility of the technique. BB formation is influenced by preoperative pathology, trephination size, and instruments used for air injection.Continue advancements have helped to refine BBT's efficacy and reproducibility, broadening its applicability in corneal transplantation whenever the endothelium is healthy.This review provides a detailed account of the procedural steps involved in DALK using the BBT, addressing the most common challenges, highlightingtechnical innovations, and handlingthe most frequent complications.
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Affiliation(s)
| | - Lorenzo Gardini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater StudiorumUniversity of Bologna, Bologna, Italy
| | - Ilaria Di Mola
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater StudiorumUniversity of Bologna, Bologna, Italy
| | - Natalie di Geronimo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater StudiorumUniversity of Bologna, Bologna, Italy
| | - Danilo Iannetta
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; University of Rome La Sapienza, Department of Organs of Sense, Rome, Italy
| | - Vito Romano
- Eye Unit, ASST Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy; Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Viale Europa 15, 25123, Brescia, Italy
| | - Sadeer B Hannush
- Cornea Service, Wills Eye Hospital, Philadelphia, PA. USA; Ophthalmology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Luigi Fontana
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater StudiorumUniversity of Bologna, Bologna, Italy.
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Lucchino L, Visioli G, Scarinci F, Colabelli Gisoldi RAM, Komaiha C, Marenco M, Pocobelli G, Lambiase A, Pocobelli A. Tomographic and topographic predictive factors of big bubble formation during deep anterior lamellar keratoplasty in keratoconus. Br J Ophthalmol 2024:bjo-2024-325810. [PMID: 39197954 DOI: 10.1136/bjo-2024-325810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/13/2024] [Indexed: 09/01/2024]
Abstract
PURPOSE To identify preoperative predictors of big bubble (BB) formation during deep anterior lamellar keratoplasty (DALK) in patients with keratoconus (KC). METHODS DESIGN: Retrospective cohort study in an Italian tertiary centre. STUDY POPULATION Consecutive patients with KC undergoing DALK from January 2021 to July 2023. OBSERVATION PROCEDURE Tomographic and topographic data including K-max, K-mean, keratometric astigmatism, thinnest point, mean peripheral corneal thickness, difference between the mean peripheral corneal thickness and the thinnest point (peripheral-minimal corneal thickness), position (central/paracentral) and cone area (%), Amsler-Krumeich classification and anterior segment optical coherence tomography (AS-OCT) analysis to assess the severity stage. MAIN OUTCOME MEASURES Rate of BB formation and type; multivariate logistic regression analysis was used to analyse all preoperative parameters in patients with BB formation versus failure. RESULTS Pneumatic dissection succeeded in 98 of 140 eyes (70.0%), with 94 type 1 bubbles (67.1%) and four type 2 bubbles (2.9%). BB formation succeeded more frequently in patients with lower K-max (p=0.032), lower K-mean (p=0.010), higher thinnest point (p=0.017), lower peripheral-minimal corneal thickness (p=0.009) and lower Amsler-Krumeich stages (p=0.021). According to the AS-OCT analysis, BB formation was more frequent in the lower stages (p<0.001). After the logistic regression (pseudo-R²=0.176, constant=3.21, 95% CI 1.14 to 5.29, p=0.002), AS-OCT classification was found to be the only factor that predicted BB formation (coefficient=-0.81, 95% CI -1.18 to -0.43, p<0.001). CONCLUSIONS AS-OCT classification is a reliable predictor for BB formation. Tomographic and topographic analyses indicated that a steeper and more ectatic cornea is more prone to BB failure.
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Affiliation(s)
- Luca Lucchino
- Department of Sense Organs, Sapienza - University of Rome, Rome, Italy
| | - Giacomo Visioli
- Department of Sense Organs, Sapienza - University of Rome, Rome, Italy
| | - Fabio Scarinci
- UOC Oftalmologia - Banca degli Occhi, San Giovanni Addolorata Hospital, Rome, Italy
| | | | - Chiara Komaiha
- UOC Oftalmologia - Banca degli Occhi, San Giovanni Addolorata Hospital, Rome, Italy
| | - Marco Marenco
- Department of Sense Organs, Sapienza - University of Rome, Rome, Italy
| | - Giulio Pocobelli
- Department of Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), University of Rome Tor Vergata, Rome, Italy
| | | | - Augusto Pocobelli
- UOC Oftalmologia - Banca degli Occhi, San Giovanni Addolorata Hospital, Rome, Italy
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3
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Son HS, Soiberman U. Big bubble formation in deep anterior lamellar keratoplasty may be more successful in early keratoconus eyes. Br J Ophthalmol 2024:bjo-2024-326213. [PMID: 39197952 DOI: 10.1136/bjo-2024-326213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 08/13/2024] [Indexed: 09/01/2024]
Affiliation(s)
- Hyeck-Soo Son
- University Eye Clinic Heidelberg, Heidelberg, Germany
| | - Uri Soiberman
- Cornea Division, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
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Lucchino L, Visioli G, Scarinci F, Colabelli Gisoldi RAM, Komaiha C, Giovannetti F, Marenco M, Pocobelli G, Lambiase A, Pocobelli A. Influence of Opacity Depth on Big Bubble Formation During Deep Anterior Lamellar Keratoplasty in Corneal Stromal Scars. Cornea 2024:00003226-990000000-00626. [PMID: 39023329 DOI: 10.1097/ico.0000000000003637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE To identify the key preoperative predictors of big bubble (BB) formation during deep anterior lamellar keratoplasty in patients with corneal stromal scars (CSS). METHODS This retrospective cohort study included consecutive patients with CSS after infective keratitis who underwent BB-deep anterior lamellar keratoplasty between January 2021 and July 2023 at a tertiary referral center. Topographic and tomographic data were collected to compare the rates and types of BB formations. Anterior segment optical coherence tomography (AS-OCT) was employed to assess the maximum depth of opacity by dividing the stroma into 3 zones of equal thickness: anterior (stage A), mid (stage B), and posterior stroma (stage C). Multivariate logistic regression analysis was performed to identify the potential preoperative predictors of bubble formation. RESULTS Pneumatic dissection was achieved in 13 of 33 eyes (39.4%), with 11 BB type 1 eyes (33.3%) and 2 BB type 2 eyes (6.1%). According to AS-OCT grading, bubble formation was more frequent with CSS involving more superficial stromal layers (P <0.032). In the eyes with stage C, bubble formation failed 12 out of 14 times (85.7%, P <0.026). Spearman correlation showed that bubble formation was inversely associated with the AS-OCT grading (rho = -0.443, P = 0.001). After logistic regression analysis, AS-OCT grading was found to be the sole factor that predicted bubble formation (coeff. -1.58, confidence interval 95% -3.03 to -0.12, P = 0.034). CONCLUSIONS Depth of opacity in CSS was the key determinant for predicting the success of pneumatic dissection, as advanced AS-OCT stages are strongly associated with BB failure.
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Affiliation(s)
- Luca Lucchino
- Department of Sense Organs, Sapienza - University of Rome, Rome, Italy
| | - Giacomo Visioli
- Department of Sense Organs, Sapienza - University of Rome, Rome, Italy
| | - Fabio Scarinci
- San Giovanni Addolorata Hospital, UOC Oftalmologia-Banca degli Occhi, Rome, Italy; and
| | | | - Chiara Komaiha
- San Giovanni Addolorata Hospital, UOC Oftalmologia-Banca degli Occhi, Rome, Italy; and
| | | | - Marco Marenco
- Department of Sense Organs, Sapienza - University of Rome, Rome, Italy
| | - Giulio Pocobelli
- Department of Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), University of Rome Tor Vergata, Rome, Italy
| | | | - Augusto Pocobelli
- San Giovanni Addolorata Hospital, UOC Oftalmologia-Banca degli Occhi, Rome, Italy; and
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Alfonso-Bartolozzi B, Fernández-Vega-Cueto L, Fernández-Vega L, Martínez-Alberquilla I, Madrid-Costa D, Alfonso JF. Triple Procedure: A Stepwise Combination of Deep Anterior Lamellar Keratoplasty and Cataract Surgery. Cornea 2024; 43:301-306. [PMID: 37603699 DOI: 10.1097/ico.0000000000003364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/05/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE The aim of this study was to evaluate clinical outcomes of the combined surgery (triple procedure) of deep anterior lamellar keratoplasty (DALK), phacoemulsification, and intraocular lens (IOL) implantation using a new surgical strategy. METHODS The study included 43 eyes of 43 patients who underwent a triple procedure. Twenty-six eyes with good visibility through the cornea underwent phacoemulsification before the stromal dissection. Seventeen eyes with bad visibility underwent the DALK procedure first until achieving enough visibility to perform the lensectomy. IOL power calculation was performed for a postoperative estimated flat keratometry of 43.5 and aiming to avoid hyperopic postoperative refraction. The postoperative visual examination included uncorrected and corrected distance visual acuity (CDVA) measurements and manifest refraction. RESULTS The mean follow-up time after suture removal was 3.06 ± 2.14 years. Mean CDVA significantly changed from 0.86 ± 0.56 logMAR preoperatively to 0.37 ± 0.28 logMAR in the last visit ( P < 0.0001). The percentage of eyes with CDVA ≤0.3 logMAR changed from 6.9% preoperatively to 62.8%. No eyes lost lines of vision after surgery, and 80% experienced an improvement of 2 or more lines. The safety index was 2.2. The mean postoperative refractive sphere was +0.13 ± 2.04 D, and the postoperative refractive cylinder was -4.02 ± 2.24 D. Only 2 cases (4.65%) obtained postoperative hyperopic astigmatism. No intraoperative complications were found. CONCLUSIONS Combined surgery of DALK, phacoemulsification, and IOL implantation is an effective and safe procedure. Depending on the corneal transparency, different surgical strategies can be established to provide more efficacy and safety.
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Affiliation(s)
| | | | | | - Irene Martínez-Alberquilla
- Clinical and Experimental Eye Research Group (CEER), Optometry and Vision Department, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - David Madrid-Costa
- Clinical and Experimental Eye Research Group (CEER), Optometry and Vision Department, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - José F Alfonso
- Fernández-Vega Ophthalmological Institute, Oviedo, Spain; and
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Yusef YN, Osipyan GA, Fisenko NV, Dzamikhova AK. [Modern techniques and features of selective keratoplasty]. Vestn Oftalmol 2024; 140:150-157. [PMID: 38739145 DOI: 10.17116/oftalma2024140022150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Selective keratoplasty involves replacing the affected layers of the cornea with similar donor tissue. In case of pathological changes in the middle and posterior stroma, deep anterior lamellar keratoplasty (DALK) is performed. Chronic corneal edema caused by endothelial dysfunction is an indication for endothelial keratoplasty - Descemet membrane endothelial keratoplasty (DMEK) or Descemet Stripping Endothelial Keratoplasty (DSAEK). Compared to penetrating keratoplasty (PK), these operations are characterized by a low risk of damage to intraocular structures and a relatively short rehabilitation period. Complications of selective keratoplasty include the formation of a false chamber between the lamellar graft and the recipient's cornea, ocular hypertension during anterior chamber air tamponade. Persistent epithelial defect can be a sign of primary graft failure in DALK, DSAEK and DMEK. Selective keratoplasty is characterized by a lower incidence of immune rejection than PK. In some cases, DALK can be complicated by corneal changes related to suture fixation of the graft. Long-term postoperative use of topical glucocorticoids can cause ocular hypertension and cataracts.
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Affiliation(s)
- Yu N Yusef
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - G A Osipyan
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - N V Fisenko
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - A K Dzamikhova
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
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Basit A, Nafees H, Khan BD, Marwat MZ, Iqbal S, Rehman SA, Abdullah M. Bubbling With Confidence: A Study of Numerous Deep Anterior Lamellar Keratoplasty Cases Using Anwar's Big Bubble Technique. Cureus 2023; 15:e46528. [PMID: 37927665 PMCID: PMC10625428 DOI: 10.7759/cureus.46528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
PURPOSE This study aims to assess the postoperative results, variability, and complications of a hundred deep anterior lamellar keratoplasty cases. Study design and duration: This is an observational study. The study was conducted at Pak International Medical College (PIMC) for a duration of four years (January 2019-January 2023). METHODOLOGY Our study collected information on a hundred cases of deep anterior lamellar keratoplasty (DALK) utilizing Anwar's big bubble technique, consisting of patients with keratoconus, superficial corneal scars, and macular dystrophy. Consenting patients had their pre and postoperative visual acuities and keratometry readings recorded. Overall success and complications were recorded and compared with the present literature. RESULTS Big bubble formation was achieved in 87% (n = 87) eyes and not achieved in 13% (n=13). There was a significant reduction in keratometry values after the procedures as well as improved vision in all patients, with 84% reporting significant improvement. Descemet membrane exposure was achieved in 91% (n=91). Complications included the failure of Anwar's big bubble formation in 13% (n=13) patients and the failure to expose Descemet's in nine patients (9%). CONCLUSION DALK using the big bubble technique is a safe and effective procedure in patients with corneal diseases who have a healthy Descemet membrane and endothelium.
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Affiliation(s)
- Abdul Basit
- Ophthalmology, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Hamid Nafees
- Ophthalmology, University Hospital Galway, Galway, IRL
| | - Bakht D Khan
- Ophthalmology, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Mir Z Marwat
- Ophthalmology, Pak International Medical College, Peshawar, PAK
| | - Sofia Iqbal
- Ophthalmology, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Saud A Rehman
- Ophthalmology, Jinnah Medical College Peshawar, Peshawar, PAK
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Iovieno A, Fontana L, Coassin M, Bovio D, Salito C. Ex Vivo Evaluation of a Pressure-Sensitive Device to Aid Big Bubble Intrastromal Dissection in Deep Anterior Lamellar Keratoplasty. Transl Vis Sci Technol 2022; 11:17. [PMID: 36580320 PMCID: PMC9804022 DOI: 10.1167/tvst.11.12.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose To develop and perform ex vivo testing for a device designed for semiquantitative determination of intracorneal dissection depth during big bubble (BB) deep anterior lamellar keratoplasty. Methods A prototype device connected to a syringe and cannula was designed to determine depth of intrastromal placement based on air rebound pressure emitted by a software controlled generator. Ex vivo testing of the device was conducted on human corneas mounted on an artificial anterior chamber in three experiments: (1) cannula purposely introduced at different depths measured with anterior segment optical coherence tomography, (2) cannula introduced as per the BB technique, and (3) simulation of the BB technique guided by the device. Results A positive pressure differential and successful BB were observed only when the cannula was positioned within 150 microns from the endothelial plane. In all successful BB cases (21/40), a repeatable increase in tissue rebound pressure was detected, which was not recorded in unsuccessful cases. The device was able to signal to the surgeon correct placement of the cannula (successful BB) in 16 of 17 cases and incorrect placement of the cannula (unsuccessful BB) in 8 of 8 cases (94.1% sensitivity, 100% specificity). Conclusions In our ex vivo model, this novel medical device could reliably signal cannula positioning in the deep stroma for effective pneumatic dissection and possibly aid technical execution of BB deep anterior lamellar keratoplasty. Translational Relevance A medical device that standardizes big bubble deep anterior lamellar keratoplasty could increase the overall success rate of the surgical procedure and aid popularization of deep anterior lamellar keratoplasty.
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Affiliation(s)
- Alfonso Iovieno
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada,IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Luigi Fontana
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Marco Coassin
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy,Department of Ophthalmology, University Campus Bio-medico, Rome, Italy
| | - Dario Bovio
- Biocubica Biomedical Engineering, Milan, Italy
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Zheng Q, Li S, Ren Y, Chen Y, Wang H, Zhao J, Chen J, Jhanji V, Chen W. Impact of cone base diameter on outcomes of deep anterior lamellar keratoplasty in keratoconus. Graefes Arch Clin Exp Ophthalmol 2022; 260:3303-3312. [PMID: 35522294 DOI: 10.1007/s00417-022-05658-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/18/2022] [Accepted: 03/31/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate the outcomes of deep anterior lamellar keratoplasty (DALK) in treating keratoconus in relation to cone base diameter (CBD). METHODS A retrospective study. Sixty-one eyes of 49 keratoconus patients who underwent DALK between 2009 and 2018 were enrolled. Preoperative and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), spherical equivalent, and astigmatism were measured. Scheimpflug tomography (Pentacam) was used to measure the cone base area (CBA) and CBD using MATLAB software. RESULTS The mean age of the patients was 20.8 ± 6.1 years old, and the mean follow-up time was 27.3 ± 15.2 months. Mean UCVA improved from 1.23 ± 0.48 to 0.57 ± 0.27 (LogMAR, 95% CI [0.52, 0.80]; P < 0.001), whereas mean BCVA improved from 0.98 ± 0.55 to 0.18 ± 0.13 (95% CI [0.66, 0.94]; P < 0.001). The mean spherical equivalent decreased by 4.53 ± 5.65 D (95% CI [- 6.25, - 2.82]; P < 0.001), with little change in astigmatism (95% CI [- 1.39, 0.64]; P = 0.457). The postoperative BCVA in the patients with CBD < 5.07 mm and corneal curvature ≥ 55D was significantly better than those whose CBD ≥ 5.07 mm (0.14 ± 0.09 vs 0.25 ± 0.15, P = 0.001). The follow-up time was negatively correlated with the BCVA (P = 0.004). CONCLUSIONS In this study, outcomes of DALK in keratoconus were related to CBD and corneal curvature. Patients with large CBD (≥ 5.07 mm) where the corneal curvature ≥ 55D are more likely to have poor visual outcomes after DALK.
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Affiliation(s)
- Qinxiang Zheng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Saiqing Li
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Yueping Ren
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Yunyun Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Haiou Wang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Jiawei Zhao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Jiaojie Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Ophthalmology, The Chinese University of Hong Kong, Hong Kong, China
| | - Wei Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China. .,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China.
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10
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Sogutlu Sari E, Kubaloglu A, Koytak A, Ofluoglu AN, Sahin G. Effect of Previous Crosslinking on Intraoperative and Postoperative Outcomes and Complication Rates of Big-Bubble Deep Anterior Lamellar Keratoplasty for Keratoconus: A Comparative Study. Cornea 2022; 41:201-205. [PMID: 34050066 DOI: 10.1097/ico.0000000000002760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/21/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare surgical outcomes and intraoperative and postoperative complications of big-bubble deep anterior lamellar keratoplasty (DALK) in patients with and without a history of previous corneal collagen crosslinking (CXL) for keratoconus. METHODS Patients with keratoconus who underwent DALK surgery with big-bubble technique between January 2013 and January 2018 were retrospectively reviewed. Operative findings, intraoperative and postoperative complications, and visual and refractive outcomes were recorded. Patients were divided into 2 groups: with previous CXL (CXL-DALK group: 27 eyes) and without previous CXL (DALK group: 50 eyes). All parameters were compared between groups. RESULTS Big bubble was successfully achieved in 24 eyes (88.9%) in the CXL-DALK group and in 45 eyes (90.0%) in the DALK group (P = 0.87). Type 1 bubble was obtained in 22 eyes (91.7%) in the CXL-DALK group and in 42 eyes (93.3%) in the DALK group (P = 0.79). Intraoperative microperforation occurred in 3 eyes (11.1%) in the CXL-DALK group and in 5 eyes (10.0%) in the DALK group (P = 1). Visual and refractive outcomes were similar between groups. The mean endothelial cell loss rates were 5.7% ± 2.3 at 1 year and 10.2 ± 3.1 at 2 years in the CXL-DALK group and 6.4% ± 4.7 at 1 year and 10.9% ± 5.4 at 2 years in the DALK group. Postoperatively, persistent epithelial defect was the most common complication in both groups, and postoperative complication rates were similar between groups. CONCLUSIONS Our results have shown that previous CXL treatment does not influence the success of bubble formation and does not increase intraoperative or postoperative complication rates of DALK surgery for keratoconus. The improvement in visual acuity and refractive errors and endothelial cell loss rates were similar between CXL treated and untreated eyes after 2 years of follow-up.
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Affiliation(s)
- Esin Sogutlu Sari
- Department of Ophthalmology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Anıl Kubaloglu
- Department of Ophthalmology, Faculty of Medicine, Dunya Eye Hospital, Yeni Yuzyil University, Istanbul, Turkey
| | - Arif Koytak
- Department of Ophthalmology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ali Nihat Ofluoglu
- Department of Ophthalmology, Faculty of Medicine, Yeni Yuzyil Universit, Istanbul, Turkey; and
| | - Gözde Sahin
- Department of Ophthalmology, Faculty of Medicine, Balıkesir University, Balıkesir, Turkey
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11
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Nair S, Kaur M, Titiyal JS. Commentary: Deep anterior lamellar keratoplasty: The challenges and solutions. Indian J Ophthalmol 2021; 69:1558-1559. [PMID: 34011740 PMCID: PMC8302323 DOI: 10.4103/ijo.ijo_845_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sridevi Nair
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Manpreet Kaur
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S Titiyal
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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