Abstract

P 024

Outcomes after big-bubble deep anterior lamellar keratoplasty (DALK) for keratoconus

Stephan Riss, Claus Cursiefen, Friedrich E. Kruse

Universitäts-Augenklinik Erlangen

Objective
Deep anterior lamellar keratoplasty (DALK) is an alternative to penetrating keratoplasty for treating corneal stroma diseases such as keratokonus. The aim of the study is to present initial results after DALK surgery using the big-bubble-technique at our department.
Methods
We evaluated 11 eyes of the first 11 patients treated with DALK using the big-bubble technique with successful bubble formation. The indications were  keratokonus (n = 10) and keratoglobus (n = 1). The main outcome measures of the study were best-corrected visual acuity, astigmatism, endothel cell count and pachymetry. Complications are described.
Results
The patients were obeserved for 3 months postoperatively. Average best-corrected visual acuity (BCVA) preoperatively was 0.25 (SD 0.22) and early postoperatively  0.32 (0.16) (p>0.05). Astigmatism could be reduced from 7.49 (SD 3.15) preoperatively to 4.85 (SD 2.44) early postoperatively (p<0.05). Endothelial cell counts revealed a value of 2237 (SD 243)/ mm2 before surgery, compared to 2068 (SD 302)/ mm2 3 months after the procedure (p>0.05). Complications included perforations (2/11) which could be handled using air injection, delayed wound healing (2/11), early suture loosening (2/11) and delayed descemet attachment (2/11).
Conclusions
DALK using the big-bubble-technique seems to be an effective and relatively safe treatment option for keratokonus and keratoglobus. In this study astigmatism could be reduced significantly 3 months after DALK, endothelial cell count and pachymetry remained stabile. To evaluate the improvement in BCVA we have to observe the patients in a longer follow-up period. No serious complications occured, minor complications could be handled safely.

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