Big bubble technique achieves better results than manual for DALK cases

STOCKHOLM, Sweden — Deep anterior lamellar keratoplasty performed with the bubble technique garners better graft survival and visual results than a manual technique or penetrating keratoplasty, according to a surgeon speaking here.

Anand Parthasarathy, MD, of the Singapore National Eye Center presented a study in which he compared 32 corneal grafts performed with the deep anterior lamellar keratoplasty Anwar big bubble technique (DALK-A) with 32 grafts performed with a manual technique (DALK-M) and 64 PK cases. The PK cases were selected from the Singapore Eye Bank database and matched with the DALK groups for age and diagnoses.

The diagnoses included keratoconus, anterior corneal stromal dystrophies and anterior corneal scarring, Dr. Parthasarathy told an audience here at the European Society of Cataract and Refractive Surgeons meeting.

The results showed no statistically significant differences in visual improvement between the PK and DALK-A groups, but outcomes in the DALK-M group were statistically significantly poorer, Dr. Parthasarathy said.

Results showed that 69% of the eyes in the DALK-A group achieved best corrected visual acuity of 6/9 or better compared with 44% in the PK group and 41% in the DALK-M group. Similarly, more eyes in the DALK-A group achieved BCVA of 6/6 compared with the other two groups.

Dr. Parthasarathy also noted better performance in the amount of steroids needed and in graft survival in the DALK-A group.

"There was a definite trend toward better graft survival in the Anwar group, and there was less duration of steroids, which is important in patients with pre-existing glaucoma," he said. "This is our preferred method of corneal transplantation for anterior stromal diseases."