PURPOSE: To evaluate the efficacy of deep lamellar keratoplasty using the big-bubble technique in patients with keratoconus. DESIGN: Interventional case series. METHODS: Thirteen eyes of 12 patients (eight male and fo...PURPOSE: To evaluate the efficacy of deep lamellar keratoplasty using the big-bubble technique in patients with keratoconus. DESIGN: Interventional case series. METHODS: Thirteen eyes of 12 patients (eight male and four female subjects) with moderate to advanced keratoconus and intolerance to contact lens wear were included in this study. Deep lamellar keratoplasty was performed by the intrastromal air injection technique. Full-thickness donor tissue devoid of Descemet membrane and endothelium was then sutured into place. Best-corrected visual acuity, refractive results, surgical technique, and complication rates were analyzed. RESULTS: Big bubble was successfully achieved in nine eyes (69.2%). Average postoperative best-corrected visual acuity was 20/25 (range 20/50 to 20/20) at a mean follow-up of 5 months. Intraoperative microperforation of Descemet membrane occurred in two eyes (15.3%). Three eyes (23%) developed a steroid-induced increase in intraocular pressure, which responded to medical therapy. CONCLUSIONS: Deep lamellar keratoplasty that uses the big-bubble technique is safe and effective in patients with keratoconus. Visual outcome is comparable to standard penetrating keratoplasty, without the risk of endothelial rejection.展开更多
PURPOSE: To evaluate the results of replacing the posterior stroma and endothelium, using small incision deep lamellar endothelial keratoplasty (DLEK) surgical techniq-ue, in patients with corneal endothelial dysfunct...PURPOSE: To evaluate the results of replacing the posterior stroma and endothelium, using small incision deep lamellar endothelial keratoplasty (DLEK) surgical techniq-ue, in patients with corneal endothelial dysfunction. DESIGN: Noncomparative case series. METHODS: Fifteen eyes of 15 patients (six males and nine females) with endothelial dysfunction were included in this study. Through a 5-mm scleral incision, a deep lamellar pocket was created across the cornea, followed by excision of an 8.0-mm disk of posterior lamellar corneal tissue. Same size lamellar donor disk was prepared and placed in position without the need of suture fixation. Best spectaclecorrected visual acuity (BSCVA), refraction, endothelial cell density, corneal topography, and corneal thickness were analyzed. RESULTS: Average BSCVA preoperative was 20/200 (range 20/40 to hand movements (HM)), improving to 20/50 (range 20/20 to 20/120) at a mean follow-up of 7.2 months. Average refractive astigmatism at last follow-up was 1.46 ±1.21 diopters (range, 0 to 4 diopters). Preoperative average donor endothelial cell density was 2047 ±311 cells/mm2, and that at last follow-up was 1732 ±514 cells/mm2. Preoperative average pachymetry was 801.4 ±211.3 μm, improving to 553 ±90.4 μm at last follow-up. CONCLUSIONS: Initial results with small incision DLEK procedure indicate that it is a safe procedure that provides healthy donor endothelial cell count and function postoperatively, with encouraging visual results.展开更多
文摘PURPOSE: To evaluate the efficacy of deep lamellar keratoplasty using the big-bubble technique in patients with keratoconus. DESIGN: Interventional case series. METHODS: Thirteen eyes of 12 patients (eight male and four female subjects) with moderate to advanced keratoconus and intolerance to contact lens wear were included in this study. Deep lamellar keratoplasty was performed by the intrastromal air injection technique. Full-thickness donor tissue devoid of Descemet membrane and endothelium was then sutured into place. Best-corrected visual acuity, refractive results, surgical technique, and complication rates were analyzed. RESULTS: Big bubble was successfully achieved in nine eyes (69.2%). Average postoperative best-corrected visual acuity was 20/25 (range 20/50 to 20/20) at a mean follow-up of 5 months. Intraoperative microperforation of Descemet membrane occurred in two eyes (15.3%). Three eyes (23%) developed a steroid-induced increase in intraocular pressure, which responded to medical therapy. CONCLUSIONS: Deep lamellar keratoplasty that uses the big-bubble technique is safe and effective in patients with keratoconus. Visual outcome is comparable to standard penetrating keratoplasty, without the risk of endothelial rejection.
文摘PURPOSE: To evaluate the results of replacing the posterior stroma and endothelium, using small incision deep lamellar endothelial keratoplasty (DLEK) surgical techniq-ue, in patients with corneal endothelial dysfunction. DESIGN: Noncomparative case series. METHODS: Fifteen eyes of 15 patients (six males and nine females) with endothelial dysfunction were included in this study. Through a 5-mm scleral incision, a deep lamellar pocket was created across the cornea, followed by excision of an 8.0-mm disk of posterior lamellar corneal tissue. Same size lamellar donor disk was prepared and placed in position without the need of suture fixation. Best spectaclecorrected visual acuity (BSCVA), refraction, endothelial cell density, corneal topography, and corneal thickness were analyzed. RESULTS: Average BSCVA preoperative was 20/200 (range 20/40 to hand movements (HM)), improving to 20/50 (range 20/20 to 20/120) at a mean follow-up of 7.2 months. Average refractive astigmatism at last follow-up was 1.46 ±1.21 diopters (range, 0 to 4 diopters). Preoperative average donor endothelial cell density was 2047 ±311 cells/mm2, and that at last follow-up was 1732 ±514 cells/mm2. Preoperative average pachymetry was 801.4 ±211.3 μm, improving to 553 ±90.4 μm at last follow-up. CONCLUSIONS: Initial results with small incision DLEK procedure indicate that it is a safe procedure that provides healthy donor endothelial cell count and function postoperatively, with encouraging visual results.
