Comparative Analysis of Two Techniques of Deep Anterior Lamellar Keratoplasty (DALK) - Big Bubble and Layer by Layer Stromal Lamellar Dissection
Journal Title: International Journal of Contemporary Medical Research - Year 2017, Vol 4, Issue 3
Abstract
Introduction: In Deep Anterior Lamellar Keratoplasty (DALK) the affected corneal stroma is replaced and the host endothelium preserved to prevent endothelial rejection. Different techniques have been described for stromal dissection to ensure a smooth and uniform recipient donor interface. The two most popular techniques are the big bubble technique which involves removing a maximal portion of the stroma and the layer by layer stromal lamellar dissection technique which leaves some posterior stroma in place. This study compares the impact of residual corneal stroma on visual outcomes. Objectives of the study were to compare outcomes following the use of two techniques of DALKbig bubble and layer by layer stromal lamellar dissection. Material and Methods: Thirty two eyes of 32 patients with corneal lesions who underwent DALK using big bubble technique were included in this prospective study and divided into 2 groups (1) bare Descemet’s membrane (DM) was achieved, (2) stromal lamellar dissection performed because of the failure of big-bubble formation. The best corrected visual acuity (BCVA), spherical equivalent, keratometric astigmatism, contrast sensitivity, endothelial cell density and Intra Ocular Pressure (IOP) were measured postoperatively at 3 and 6 months in both groups. Result: BCVA at 3 months was better in group 1 (P=0.034), however at 6 months it was comparable (P=0.123). Spherical equivalence, keratometric astigmatism, endothelial density, and IOP were statistically indifferent at 3months (P = 0.509, 0.42, 0.22, 0.864 respectively) and 6 months (P=0.983, 0.28, 0.17, 0.864 respectively). Contrast sensitivity was better in group 1 both at 3(P=0.038) and 6 months (P=0.035). Conclusion: Though visual outcome was better in the big bubble group in the early post operative period, later results were comparable in both groups.
Authors and Affiliations
Krishna Kanta Roy, Sandeep Shankar, Alok Sati, P S Moulick, Shyamal Roy, Faizanul Haque
Keywords
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