Evaluation of deep anterior lamellar keratoplasty for anterior corneal stromal pathology

Settings This study was conducted in Mansoura Ophthalmic Center, Mansoura University, Egypt, during the period from January 2018 to January 2019. Purpose This study aimed to evaluate the visual outcomes, topographic features, endothelial cell densities (ECD), and complications of deep anterior lamellar keratoplasty using big-bubble technique (BB-DALK) in different corneal stromal pathologies. Patients and methods This was a prospective, interventional study that included 24 eyes of 24 patients having corneal stromal pathologies, not involving Descemet membrane (DM) and endothelium. The primary outcome measures were the clinical, visual, and topographic outcomes (uncorrected visual acuity, best-corrected visual acuity, K1, and K2) throughout the follow-up period, whereas the secondary outcome measures were the refractive outcomes, central corneal thickness, ECD, and intraoperative and postoperative complications. Results A total of 21 (87.5%) patients underwent uneventful BB-DALK, and three (12.5%) cases were complicated by intraoperative DM microperforation who developed DM detachment and double anterior chamber (AC) postoperatively. One of them resolved spontaneously and the other two cases required intracameral air injection. Uncorrected visual acuity improved from 1.55±0.26 (logarithm of minimum angle of resolution) preoperatively to 0.63±0.2 1 year postoperatively (P<0.001) and best-corrected visual acuity improved from 1.08±0.11 (logarithm of minimum angle of resolution) to 0.30±0.12 (P=0.017). Refractive cylinder improved from −7.79±1.75 to −2.85±2.01 at 12 months of follow-up (P=0.007). Average K reading changed from 60.00±7.77 preoperatively to 43.43±2.98 postoperatively (P<0.001). Total ECD was 2248.08±431.13 by the end of the first year, with a mean of 8.2% endothelial cell loss. Loosening of the sutures occurred in five (20.8%) eyes between third and sixth months postoperatively. Urrets-Zavalia syndrome occurred in one of the two cases who were complicated with postoperative double AC and required intracameral air injection. Conclusions BB-DALK is an effective and safe technique for treatment of different corneal stromal pathologies sparing endothelium and DM.