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Anwar's 'big bubble' technique has the highest incidence of Descemet's exposure in DALK
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ROME — Manually performed deep anterior lamellar keratoplasty with Anwar's "big bubble" technique is the best procedure to restore corneal function and transparency when the endothelium is healthy, according to a speaker here.
At the European Society of Cataract and Refractive Surgeons winter meeting, Vincenzo Sarnicola, MD, presented the results of a retrospective evaluation of 338 eyes of 275 patients who underwent deep anterior lamellar keratoplasty (DALK) with different surgical techniques between 2000 and 2007.
Over the years, different techniques have been proposed, aimed at the Descemetic plane (dDALK) or pre-Descemetic plane (pdDALK), he said. Dr. Sarnicola said he prefers Anwar's big bubble technique with full exposure of the Descemet's membrane.
The main outcome measures of the study were the ability to successfully expose the Descemet's membrane (dDALK), the number of cases in which the pre-Descemetic plane was reached (pdDALK), pre- and postoperative visual acuity, and endothelial cell count.
"A total of 219 patients fell under the dDALK group, with the Anwar technique showing the highest incidence of exposure of Descemet's membrane (207 of 266 cases, or 78%)," Dr. Sarnicola said.
Descemet ruptures occurred in 28 of 338 cases. Three ruptures were converted to penetrating keratoplasty. There was no difference in visual acuity between the dDALK and pdDALK groups at an average follow-up of 30.7 months, although the eyes in the dDALK group seemed to have faster visual recovery.
Best corrected visual acuity postoperatively was at least 20/30 in 80% to 85% of eyes at the last visit. Endothelial cell loss ranged from 11% to 13%, with most of the loss occurring in the first 6 months and remaining stable for the rest of the follow-up.