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Outcomes of big-bubble deep anterior lamellar keratoplasty for pediatric keratoconus
Sepehr Feizi1, Mohammad Ali Javadi2, Maryam Najafi2
1Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Boostan 9 St, Pasdaran Avenue, Tehran, 16666, Iran. sepehrfeizi@yahoo.com.
Insights
Big-bubble deep anterior lamellar keratoplasty (DALK) shows promising outcomes for pediatric keratoconus, significantly improving visual acuity and reducing corneal curvature. Close follow-up is crucial for managing potential complications in young patients.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Pediatric Eye Care
Background:
- Keratoconus is a progressive corneal ectasia affecting young individuals.
- Deep anterior lamellar keratoplasty (DALK) is an alternative to penetrating keratoplasty for keratoconus.
- Pediatric keratoconus presents unique challenges in surgical management and visual rehabilitation.
Purpose of the Study:
- To evaluate the efficacy and safety of big-bubble deep anterior lamellar keratoplasty (DALK) in children with keratoconus.
- To assess visual outcomes, refractive changes, and complication rates associated with pediatric DALK.
Main Methods:
- Retrospective analysis of 44 eyes from 39 children (≤18 years) with keratoconus.
- All patients underwent big-bubble DALK between March 2004 and June 2016.
- Outcome measures included best spectacle-corrected visual acuity (BSCVA), manifest refraction, keratometry, and complication analysis.
Main Results:
- Successful big bubble achieved in 75% of cases; predescemetic DALK in 25%.
- Mean BSCVA improved significantly from 1.34 LogMAR preoperatively to 0.24 LogMAR postoperatively (P < 0.001).
- Mean keratometry decreased from 59.54 D to 46.23 D (P < 0.001); 90.9% of grafts were clear at follow-up.
Conclusions:
- Big-bubble DALK demonstrates promising visual and refractive outcomes in pediatric keratoconus.
- Complications, including graft issues and suture-related problems, were observed.
- Frequent follow-up and parental involvement are essential for managing postoperative complications in children.
Purpose:
To evaluate the outcomes and complications of deep anterior lamellar keratoplasty (DALK) performed for pediatric keratoconus.
Methods:
This retrospective study enrolled 44 consecutive eyes of 39 keratoconus-affected children (≤ 18 years of age). All patients underwent big-bubble DALK from March 2004 to June 2016. The outcome measures included postoperative best spectacle-corrected visual acuity (BSCVA), manifest refraction, keratometry readings, and complications.
Results:
The mean participant age was 16.8 ± 1.4 years, and the mean follow-up period was 68.5 ± 39.9 months. Successful big bubble was achieved in 33 eyes (75.0%), while the surgical technique was predescemetic DALK in 11 (25.0%). The mean BSCVA changed from 1.34 ± 0.49 LogMAR preoperatively to 0.24 ± 0.10 LogMAR postoperatively (P < 0.001). The mean keratometry decreased from 59.54 ± 5.17 D preoperatively to 46.23 ± 2.17 D postoperatively (P < 0.001). The complications encountered during the study period were intraoperative Descemet's membrane perforation (n = 5, 11.4%), the Urrets Zavalia syndrome (n = 1, 2.3%), graft epithelial problems (n = 3, 6.8%), subepithelial graft rejection (n = 5, 11.4%), high intraocular pressure (n = 8, 18.2%), and traumatic wound dehiscence (n = 2, 4.6%). Suture-related complications included premature loosening (n = 13, 29.6%), broken sutures (n = 12, 27.3%), suture-tract vascularization (n = 6, 13.6%), suture-associated abscesses (n = 5, 11.4%), and suture cheese wiring (n = 2, 4.6%). A clear graft was found in 40 eyes (90.9%) at the last follow-up examination.
Conclusion:
This study showed promising results with big-bubble DALK in keratoconus-affected children. A frequent and close follow-up with dedicated parental involvement is essential for the early recognition and management of postoperative complications.
