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The cannula technique for deep anterior lamellar keratoplasty (DALK) resulted in a higher success rate for descemetic DALK compared to the needle technique. Air viscobubble (AVB) proved effective in rescuing big bubble failures during DALK procedures.

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Area of Science:

  • Ophthalmology
  • Corneal Surgery
  • Lamellar Keratoplasty

Background:

  • Keratoconus is a progressive thinning disorder of the cornea.
  • Deep anterior lamellar keratoplasty (DALK) is a surgical option for keratoconus, aiming to replace the diseased stroma while preserving host Descemet membrane and endothelium.
  • Comparing different DALK techniques is crucial for optimizing surgical outcomes.

Purpose of the Study:

  • To compare the outcomes of two deep anterior lamellar keratoplasty (DALK) techniques: cannula big-bubble DALK and needle big-bubble DALK (Anwar technique).
  • To evaluate the advantages and success rates of each DALK method in keratoconus patients.

Main Methods:

  • A retrospective study analyzed 507 eyes with keratoconus undergoing DALK between 2002 and 2012.
  • Two techniques were compared: needle DALK (266 eyes) and cannula DALK (241 eyes).
  • Air viscobubble (AVB) was used as a rescue technique for big bubble (BB) failure, with manual dissection as a last resort. Outcomes included dDALK, pdDALK, bubble formation, Descemet membrane rupture, and conversion to penetrating keratoplasty.

Main Results:

  • The cannula DALK group achieved a significantly higher rate of descemetic DALK (dDALK) at 94% compared to the needle DALK group at 78% (P < 0.01).
  • Predescemetic DALK (pdDALK) occurred in 6% of cannula cases versus 22% of needle cases.
  • No penetrating keratoplasty conversions were required in either group, and AVB was successful in rescuing BB failures.

Conclusions:

  • The smooth cannula technique for DALK offers a statistically significant higher success rate for dDALK and is more manageable than the needle technique.
  • Air viscobubble (AVB) serves as an effective rescue strategy when big bubble formation fails during DALK.