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ORIGINAL ARTICLE
Year : 2014  |  Volume : 107  |  Issue : 3  |  Page : 166-172

Comparative study between DALK using the big-bubble technique and penetrating keratoplasty in corneal stromal opacities


Department of Ophthalmology, Kasr El Aini Hospital, Cairo University, Cairo, Egypt

Correspondence Address:
Dalia H Abdel Raouf
Department of Ophthalmology, Kasr El Aini Hospital, Cairo University, 8 Mohei el din street, Dokki, Cairo 12311
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2090-0686.148133

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Objectives To compare between deep anterior lamellar keratoplasty (DALK) using the big-bubble technique and penetrating keratoplasty (PK) in terms of visual and refractive outcomes, endothelial cell density (ECD), and contrast sensitivity in patients with corneal stromal opacities. Design A prospective interventional comparative study was carried out from April 2011 to August 2012. The follow-up duration was 12 months postoperatively. Patients and methods Thirty eyes of 30 patients presenting to the outpatient clinic in Kasr El Aini Hospital, Cairo University who fulfilled the inclusion criteria were studied. The inclusion criteria were as follows: best-corrected visual acuity (BCVA) less than 6/36, with an intact endothelium/descemet membrane complex by ultrasound biomicroscopy. The exclusion criteria were as follows: full-thickness corneal pathology involving the descemet membrane, endothelial dysfunction, intraocular pathology, ectatic corneal conditions, previous intraocular surgeries, lid abnormalities, active keratitis, or dry eye. They were divided into two groups: group A included 15 patients in whom the big-bubble technique was used successfully and group B included 15 patients operated upon by PK. Postoperative follow-up was carried out with group masking in terms of the following: BCVA, refraction, ECD contrast sensitivity using the Functional Acuity Contrast test, contrast sensitivity chart, intraocular pressure, and ultrasound biomicroscopy assessment of graft thickness. Results All patients completed the 12-month follow-up. The significance level was set at P-value less than or equal to 0.05. ECD showed a greater decrease in the PK group, with the mean ECD attained at 3 months in the DALK group compared with the PK group reaching a statistically significant level at the end of the 12 months (P = 0.001). The mean refractive astigmatism and the mean number of days needed for the cornea to clear were significantly less (P = 0.035 and 0.001 respectively) in the big-bubble DALK group. In terms of BCVA, the final mean graft thickness, postoperative contrast sensitivity, and intraocular pressure, there was no significant difference between both groups (P > 0.05). Conclusion The big-bubble technique is superior to PK in terms of ECD, mean refractive astigmatism, and early corneal clarity.


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