This article is more than 5 years old. Information may no longer be current.
Big bubble DALK for keratoconus yields fewer complications than PK
Click Here to Manage Email Alerts
SAN FRANCISCO — Anterior lamellar keratoplasty is a viable alternative to penetrating keratoplasty, particularly in treating keratoconus, a surgeon said here.
Deep anterior lamellar keratoplasty (DALK) performed with the big bubble technique showed strong results in a recent study, Donald T. H. Tan, FRCS, said during Cornea Day preceding the American Society of Cataract and Refractive Surgery meeting.
"Clearly it has advantages in outcome and graft survival over PK," Dr. Tan said.
The retrospective case study compared visual outcomes, complications and graft failure rates of DALK and penetrating keratoplasty (PK). It included 103 cases of PK and 103 DALKs (52 cases with manual dissection and 51 cases with the big bubble).
In a subset of procedures for keratoconus, DALK resulted in markedly lower rates of complications. For example, at 3-year follow-up, big bubble DALK yielded a mean 7% endothelial cell loss, while PK resulted in a mean 38% loss. DALK also resulted in lower increases in IOP and less cataract formation/progression than PK, Dr. Tan said.
"This is clearly a validation that there are less complications with big bubble surgery," he said.
DALK offered slower visual recovery compared to PK but showed significant improvements at 3 years, he said.
"You have to remember that DALKs take a little bit longer for visual recovery," Dr. Tan said. "Sometimes, if you wait 1 year or 18 months, they just get better and better. I've seen cases of 20/50 in the first year, 20/30 in the second year and 20/20 in year 3. So, sometimes if the patient can wait, then just wait."