Visual acuity and refraction after deep anterior lamellar keratoplasty with and without successful big-bubble...

To compare visual acuity and refractive outcomes after Anwar's deep anterior lamellar keratoplasty (DALK) between eyes with and without successful big-bubble formation.

In this retrospective comparative study, keratoconic eyes undergoing DALK with the big-bubble technique were divided into 2 groups: group 1 in which a bared Descemet membrane (DM) was achieved and group 2 in which layer-by-layer manual dissection was performed because of the lack of big-bubble formation after several intrastromal air injections. The 2 groups were compared with respect to best spectacle-corrected visual acuity, keratometric astigmatism, and refractive error at months 1, 3, 6, and 12, and at least 3 months after complete suture removal.

A total of 123 keratoconic eyes were enrolled. A bared DM was successfully achieved in 100 eyes (81.3%) (group 1), whereas in 23 eyes (18.7%) (group 2), some posterior stroma was left in place. The mean follow-up period was 21 ± 9 months in group 1 and 23 ± 9 months in group 2 (P = 0.37). Postoperative best spectacle-corrected visual acuity was significantly better in group 1 than in group 2 at months 1, 3, 6, and 12. But, at the final examinations, there was no significant difference between the study groups (0.24 ± 0.21 logarithm of the minimum angle of resolution in group 1 and 0.32 ± 0.14 logarithm of the minimum angle of resolution in group 2; P = 0.18). The 2 groups were comparable regarding keratometric astigmatism and spherical equivalent refractive error throughout the follow-up period.

Retention of posterior corneal stroma delayed visual recovery after DALK using Anwar's technique, but the participants in this group ultimately reached the same levels of visual acuity as observed in the bared-DM group.