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Blunt Scissors Stromal Dissection Technique Compared With Big-Bubble Deep Anterior Lamellar Keratoplasty

Ucgul, Ahmet Yucel, M.D.; Yesilirmak, Nilufer, M.D.; Yuvarlak, Armagan, M.D.; Aydin, Bahri, M.D.; Ozmen, Mehmet Cuneyt, M.D., F.I.C.O.; Akata, Fikret, M.D.

doi: 10.1097/ICL.0000000000000557

Objectives: To evaluate the clinical findings and results of new modified manual deep anterior lamellar keratoplasty (M-DALK) technique compared with a big-bubble DALK (BB-DALK) technique in eyes with corneal scars or lesions.

Methods: A prospective, nonrandomized, comparative study included 65 eyes of 65 patients treated by M-DALK using the blunt scissors lamellar dissection technique or standard BB-DALK. Visual acuity, endothelial cell density, corneal cylinder (Cyl), central corneal thickness (CCT), residual stromal thickness and aberrometric values were recorded pre-treatment and 1, 3, 6, 12 and 18 months after treatment.

Results: Thirty-five eyes of 35 patients underwent deep anterior lamellar keratoplasty (DALK) with successful big-bubble technique, whereas 30 eyes of 30 patients underwent DALK with manual technique (in 10 eyes as a primary technique, in 20 eyes as a secondary technique). Successful big-bubble formation was achieved in 35 of 55 (64%) eyes. Microperforations occurred in three eyes in BB-DALK group, in six eyes in M-DALK group, and DALK could be completed successfully in these eyes. Visual acuity and endothelial cell loss results were not significantly different between groups during follow-up period. Mean CCT was significantly different between groups (P=0.035). Mean corneal Cyl, residual stromal thickness, and aberrometric values were similar between groups (P>0.05) at the final visit.

Conclusion: New modified M-DALK technique has similar clinical findings and results with BB-DALK when using as a primary or secondary approach.

Department of Cornea (A.Y.U., N.Y., A.Y., B.A., M.C.O., F.A.), Gazi University Hospital, Ankara, Turkey; Department of Ophthalmology (N.Y.), Yildirim Beyazit University Hospital, Ankara, Turkey; and Department of Ophthalmology (A.Y.), Urfa Training and Research Hospital, Urfa, Turkey.

Address correspondence to Nilufer Yesilirmak, M.D., Department of Cornea, Gazi University Hospital, 06500 Besevler, Ankara, Turkey; e-mail:

The author has no funding or conflicts of interest to disclose.

Accepted September 24, 2018

© 2019 Contact Lens Association of Ophthalmologists, Inc.