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Deep Anterior Lamellar Keratoplasty Versus Penetrating Keratoplasty for Keratoconus: A Clinical Trial

Javadi, Mohammad Ali MD; Feizi, Sepehr MD; Yazdani, Shahin MD; Mirbabaee, Firooz MD

doi: 10.1097/ICO.0b013e3181b81b71
Clinical Science

Purpose: To compare deep anterior lamellar keratoplasty (DALK) using the big-bubble technique to penetrating keratoplasty (PK) in patients with keratoconus.

Materials and Methods: In this clinical trial, patients with moderate to advanced keratoconus with poor spectacle-corrected visual acuity and intolerant to contact lens wear were enrolled. DALK was performed using the big-bubble technique, and a full-thickness donor cornea without Descemet membrane was sutured to the recipient bed. PK was performed conventionally with a Hessburg-Barron suction trephine. Three types of suturing were used for both groups. Postoperative refractive errors, best-corrected visual acuity (BCVA), contrast sensitivity function (CSF), and higher order aberrations (HOAs) were compared between the study groups.

Results: The study included 81 eyes of 81 patients. Forty-six eyes underwent DALK from which 4 were excluded because of failure to achieve bared Descemet membrane. Thirty-five eyes received PK. Mean patient age was 26.91 ± 7.9 versus 30.89 ± 10.3 years in the DALK and PK groups, respectively (P = 0.06). Mean follow-up period was 22.0 ± 7.9 months in the DALK group and 24.6 ± 3.5 months in the PK group (P = 0.32). Mean postoperative spherical equivalent refractive error was −3.23 ± 3.4 diopters in the DALK group versus −2.22 ± 4.6 diopters in the PK group (P = 0.28), and mean postoperative BCVA was 0.18 ± 0.08 and 0.15 ± 0.10 logarithm of the minimum angle of resolution, respectively (P = 0.12). CSF and total aberrations and HOAs were comparable in the study groups.

Conclusions: DALK is an effective alternative surgical procedure for patients with keratoconus; the outcomes are comparable to PK in terms of refractive errors, BCVA, CSF, and HOAs.

From the Ophthalmic Research Center and Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University, M.C., Tehran, Iran.

Received for publication February 7, 2009; revision received July 7, 2009; accepted July 18, 2009.

There is no financial or propriety interest in any materials used in this article.

Reprints: Mohammad Ali Javadi, MD, Ophthalmology Department and Ophthalmic Research Center, Labbafinejad Medical Center, Boostan 9 St, Pasdaran Avenue, Tehran 16666, Iran (e-mail:

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