Özet:

Objective:To report the perioperative complications and clinical outcomes after deep anterior lamellar keratoplasty (DALK) using the big bubble technique in eyes with healthy endothelium. Methods:This retrospective, interventional case series demonstrated the data of 120 eyes in 105 patients who underwent DALK. Data on preoperative status, operative details, intraoperative and postoperative complications, secondary interventions, and visual outcomes were analyzed. Results:The study included 54 (51.5%) females and 51 (48.5%) males patients. Mean age was 30.9 ± 13.8 (12-75) years. Preoperative indications were keratoconus in 80 (66.7%), corneal dystrophy in 20 (16.7%), traumatic corneal scar in 8 (6.7%), postherpetic keratitis 6 (5%), chemical burn 2 (1.6%), Salzmann nodular degeneration 1 (0.8%) and nonspecific corneal opacity 3 (2.5%) eyes. Complete Descemet membrane exposure via big bubble could be achieved in 96 cases (80%). Four (3.3%) required layer-by-layer manual dissection. A total of 20 (16.7%) were converted to penetrating keratoplasty (PK) intraoperatively. Best spectacle–corrected visual acuity of 5/10 or better was present in 29 eyes postoperatively. The mean spherical equivalent and topographic astigmatism were –2.50 ± 2.25 and –2.50 ± 2.25 diopter, respectively. There were two instances of stromal graft rejection, which responded to medical therapy. Postoperative glaucoma diagnosed in four eyes and one of them necessitated trabeculectomy. Conclusion:DALK big-bubble technique may be a valuable and an effective procedure in the treatment of patients with healthy endothelium. The visual and refractive outcomes are comparable to standard penetrating keratoplasty, avoiding the risk of endothelial rejection.

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