outcomes of deep anterior lamellar keratoplasty in patients with keratoconus using the big-bubble technique

purpose: to evaluate visual outcomes after deep anterior lamellar keratoplasty (dalk) in patients with keratoconus. methods: in this interventional case series, patients with moderate to advanced keratoconus underwent dalk. inclusion criteria consisted of contact lens intolerance or poor spectacle-corrected visual acuity. dalk was performed using the big-bubble technique introduced by anwar and teichmann. outcome measures included visual acuity, refractive status, effect of different methods of suturing on visual outcomes and intraoperative and postoperative complications. results: one-hundred and twenty-six consecutive eyes of 121 patients were included. at the time of surgery, mean patient age and mean follow-up period were 26.08±7.6 years and 21.62±9.0 months, respectively. mean preoperative uncorrected and best corrected visual acuity were 20/500 and 20/400, increasing to 20/80 and 20/32 after the operation, respectively (p<0.001). postoperatively mean spherical refractive error and refractive and keratometric astigmatism were -3.41±3.1 d, 3.04±2.3 d, and 3.67±2.1 d, respectively. bared dm was achieved in 100 (81.3%) eyes, however, in 23 (18.7%) eyes a few layers of the stroma remained. conclusion: dalk using the big-bubble technique appears to be an effective procedure for patients with keratoconus. in the case of extensive intraoperative dm perforation or postoperative complications, pk could be done without any limitation.