Mohammad Ali Javadi1, Sepehr Feizi, Shahin Yazdani, Firooz Mirbabaee. 1. Ophthalmic Research Center and Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University, Boostan 9 St., Pasdaran Avenue, Tehran, Iran. ma_javadi@yahoo.com
Abstract
PURPOSE: To compare deep anterior lamellar keratoplasty (DALK) using the big-bubble technique to penetrating keratoplasty (PK) in patients with keratoconus. MATERIALS AND METHODS: In this clinical trial, patients with moderate to advanced keratoconus with poor spectacle-corrected visual acuity and intolerant to contact lens wear were enrolled. DALK was performed using the big-bubble technique, and a full-thickness donor cornea without Descemet membrane was sutured to the recipient bed. PK was performed conventionally with a Hessburg-Barron suction trephine. Three types of suturing were used for both groups. Postoperative refractive errors, best-corrected visual acuity (BCVA), contrast sensitivity function (CSF), and higher order aberrations (HOAs) were compared between the study groups. RESULTS: The study included 81 eyes of 81 patients. Forty-six eyes underwent DALK from which 4 were excluded because of failure to achieve bared Descemet membrane. Thirty-five eyes received PK. Mean patient age was 26.91 ± 7.9 versus 30.89 ± 10.3 years in the DALK and PK groups, respectively (P = 0.06). Mean follow-up period was 22.0 ± 7.9 months in the DALK group and 24.6 ± 3.5 months in the PK group (P = 0.32). Mean postoperative spherical equivalent refractive error was -3.23 ± 3.4 diopters in the DALK group versus -2.22 ± 4.6 diopters in the PK group (P = 0.28), and mean postoperative BCVA was 0.18 ± 0.08 and 0.15 ± 0.10 logarithm of the minimum angle of resolution, respectively (P = 0.12). CSF and total aberrations and HOAs were comparable in the study groups. CONCLUSIONS:DALK is an effective alternative surgical procedure for patients with keratoconus; the outcomes are comparable to PK in terms of refractive errors, BCVA, CSF, and HOAs.
RCT Entities:
PURPOSE: To compare deep anterior lamellar keratoplasty (DALK) using the big-bubble technique to penetrating keratoplasty (PK) in patients with keratoconus. MATERIALS AND METHODS: In this clinical trial, patients with moderate to advanced keratoconus with poor spectacle-corrected visual acuity and intolerant to contact lens wear were enrolled. DALK was performed using the big-bubble technique, and a full-thickness donor cornea without Descemet membrane was sutured to the recipient bed. PK was performed conventionally with a Hessburg-Barron suction trephine. Three types of suturing were used for both groups. Postoperative refractive errors, best-corrected visual acuity (BCVA), contrast sensitivity function (CSF), and higher order aberrations (HOAs) were compared between the study groups. RESULTS: The study included 81 eyes of 81 patients. Forty-six eyes underwent DALK from which 4 were excluded because of failure to achieve bared Descemet membrane. Thirty-five eyes received PK. Mean patient age was 26.91 ± 7.9 versus 30.89 ± 10.3 years in the DALK and PK groups, respectively (P = 0.06). Mean follow-up period was 22.0 ± 7.9 months in the DALK group and 24.6 ± 3.5 months in the PK group (P = 0.32). Mean postoperative spherical equivalent refractive error was -3.23 ± 3.4 diopters in the DALK group versus -2.22 ± 4.6 diopters in the PK group (P = 0.28), and mean postoperative BCVA was 0.18 ± 0.08 and 0.15 ± 0.10 logarithm of the minimum angle of resolution, respectively (P = 0.12). CSF and total aberrations and HOAs were comparable in the study groups. CONCLUSIONS: DALK is an effective alternative surgical procedure for patients with keratoconus; the outcomes are comparable to PK in terms of refractive errors, BCVA, CSF, and HOAs.
Authors: Seth M Pantanelli; Ramkumar Sabesan; Steven S T Ching; Geunyoung Yoon; Holly B Hindman Journal: Invest Ophthalmol Vis Sci Date: 2012-07-20 Impact factor: 4.799
Authors: Alex W Cohen; Kenneth M Goins; John E Sutphin; George R Wandling; Michael D Wagoner Journal: Int Ophthalmol Date: 2010-09-23 Impact factor: 2.031