Deep anterior lamellar keratoplasty by big-bubble technique for treatment corneal stromal opacities

PURPOSE: To evaluate the efficacy of using the big-bubble technique of deep anterior lamellar keratoplasty (DALK) for newer indications. DESIGN: Prospective, noncomparative, interventional case series. METHODS: Ten eyes of eight patients with pathologies involving the corneal stroma and sparing the Descemet membrane (DM) were included in this study conducted at a tertiary care hospital. The indications for DALK included corneal clouding attributable to mucopolysaccharidoses (n = 2), macular corneal dystrophy (n = 5), lattice corneal dystrophy (n = 1), granular corneal dystrophy (n = 1), and stromal scar attributable to infectious keratitis (n = 1). DALK was performed using the big-bubble technique in order to achieve the complete separation of DM from the corneal stromal tissue in the recipient's eye. Subsequently, the corneal stromal tissue was excised completely, and a full-thickness donor corneal lenticule without its DM was secured over the bared DM of the host. The main outcome measures of the study were the ability to successfully bare DM, the gain in visual acuity, and the presence of any complications. RESULTS: Using the big-bubble technique, DM was bared, and DALK could be performed successfully in all eyes. No intraoperative or postoperative complications were observed. All patients achieved a best-corrected visual acuity (BCVA) of 20/40 or better at the end of six months. CONCLUSIONS: DALK using the big-bubble technique can be useful in treating corneal stromal dystrophies, corneal clouding attributable to mucopolysaccharidoses, and stromal scar attributable to infectious keratitis.