Rasik B Vajpayee1, Prafulla K Maharana2, Namrata Sharma2, Tushar Agarwal2, Vishal Jhanji2. 1. From Dr. Rajendra Prasad Centre for Ophthalmic Sciences (Vajpayee, Maharana, Sharma, Agarwal), All India Institute of Medical Sciences, New Delhi, India; the Centre for Eye Research Australia (Vajpayee, Jhanji), University of Melbourne, Australia; the Department of Ophthalmology and Visual Sciences (Jhanji), Chinese University of Hong Kong, Hong Kong. Electronic address: rasikv@unimelb.edu.au. 2. From Dr. Rajendra Prasad Centre for Ophthalmic Sciences (Vajpayee, Maharana, Sharma, Agarwal), All India Institute of Medical Sciences, New Delhi, India; the Centre for Eye Research Australia (Vajpayee, Jhanji), University of Melbourne, Australia; the Department of Ophthalmology and Visual Sciences (Jhanji), Chinese University of Hong Kong, Hong Kong.
Abstract
PURPOSE: To evaluate the outcomes of a new surgical technique, diamond knife-assisted deep anterior lamellar keratoplasty (DALK), and compare its visual and refractive results with big-bubble DALK in cases of keratoconus. SETTING: Tertiary eyecare hospital. DESIGN: Comparative case series. METHODS: The visual and surgical outcomes of diamond knife-assisted DALK were compared with those of successful big-bubble DALK. RESULTS: Diamond knife-assisted DALK was performed in 19 eyes and big-bubble DALK, in 11 eyes. All surgeries were completed successfully. No intraoperative or postoperative complications occurred with diamond knife-assisted DALK. Six months after diamond knife-assisted DALK, the mean corrected distance visual acuity (CDVA) improved significantly from 1.87 logMAR ± 0.22 (SD) to 0.23 ± 0.06 logMAR, the mean keratometry improved from 65.99 ± 8.86 diopters (D) to 45.13 ± 1.16 D, and the mean keratometric cylinder improved from 7.99 ± 3.81 D to 2.87 ± 0.59 D (all P=.005). Postoperatively, the mean refractive astigmatism was 2.55 ± 0.49 D and the mean spherical equivalent was -1.97 ± 0.56 D. The mean logMAR CDVA (P = .06), postoperative keratometry (P=.64), refractive cylinder (P=.63), and endothelial cell loss (P=.11) were comparable between diamond knife-assisted DALK and big-bubble DALK. CONCLUSIONS: Diamond knife-assisted DALK was effective and predictable as a surgical technique for management of keratoconus cases. This technique has the potential to offer visual and refractive outcomes comparable to those of big-bubble DALK. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
PURPOSE: To evaluate the outcomes of a new surgical technique, diamond knife-assisted deep anterior lamellar keratoplasty (DALK), and compare its visual and refractive results with big-bubble DALK in cases of keratoconus. SETTING: Tertiary eyecare hospital. DESIGN: Comparative case series. METHODS: The visual and surgical outcomes of diamond knife-assisted DALK were compared with those of successful big-bubble DALK. RESULTS: Diamond knife-assisted DALK was performed in 19 eyes and big-bubble DALK, in 11 eyes. All surgeries were completed successfully. No intraoperative or postoperative complications occurred with diamond knife-assisted DALK. Six months after diamond knife-assisted DALK, the mean corrected distance visual acuity (CDVA) improved significantly from 1.87 logMAR ± 0.22 (SD) to 0.23 ± 0.06 logMAR, the mean keratometry improved from 65.99 ± 8.86 diopters (D) to 45.13 ± 1.16 D, and the mean keratometric cylinder improved from 7.99 ± 3.81 D to 2.87 ± 0.59 D (all P=.005). Postoperatively, the mean refractive astigmatism was 2.55 ± 0.49 D and the mean spherical equivalent was -1.97 ± 0.56 D. The mean logMAR CDVA (P = .06), postoperative keratometry (P=.64), refractive cylinder (P=.63), and endothelial cell loss (P=.11) were comparable between diamond knife-assisted DALK and big-bubble DALK. CONCLUSIONS: Diamond knife-assisted DALK was effective and predictable as a surgical technique for management of keratoconus cases. This technique has the potential to offer visual and refractive outcomes comparable to those of big-bubble DALK. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.