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

Abstract

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.

Therapeutic effect of deep anterior lamellar keratoplasty for active or quiescent herpetic stromal keratitis

“…It was determined that allograft rejection episodes after DALK were fewer and milder compared to those after PK [24]. Endothelial rejection can be largely reduced by retaining endothelium during the DALK procedure [25]. In our series, the allograft rejection rate after DALK was 2.3% (one eye), which was significantly lower than that after PK (28.4%, 21 of 74 eyes), in the treatment of HSK at our institution [17].…”

Long-Term Outcomes of Deep Anterior Lamellar Keratoplasty Treating Posterior Stroma–Implicated Herpetic Corneal Opacities

“…The mean endothelial cell count 6 to 12 months after surgery was 2458 6 330 cells per square millimeter. 15 Another report demonstrated that the endothelial cell count 6 and 12 months after DALK was 1908 6 516 cells per square millimeter and 1835 6 491 cells per square millimeter, respectively. 25 Our results showed that the endothelial cell count after a mean follow-up of 50 months was 1738 6 573 cells per square millimeter, even when the preoperative corneal scars reached near the level of DM.…”

“…[14][15][16] In addition to the obvious advantage of absence of endothelial graft rejection, DALK allows the use of poor-quality donor corneas thereby alleviating the problem of shortage of donor corneas in the developing world. 20,21 Considering these factors, we performed DALK for patients with deep HSKinduced corneal scars with functional endothelium.…”

“…Previous studies have reported encouraging outcomes of DALK in treating HSK-related corneal scarring in which posterior lamella and endothelium were not compromised. [14][15][16] These reports indicated that the depth of the scar should not exceed two thirds of the stroma. In this study, we report the long-term outcomes of DALK in deep stromal HSK-related corneal scars with or without associated posterior stromal folds approaching the endothelium.…”

Deep Anterior Lamellar Keratoplasty for Ectatic Disease

“…29 The development of DALK techniques and the improved quality of the donor button preparation have resulted in significantly better visual acuity outcomes. 15,16,20,62,[85][86][87][88] …”