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Comparison of Descemet-On Versus Descemet-Off Deep Anterior Lamellar Keratoplasty

Zare, Mohammad MD; Feizi, Sepehr MD, MSc; Hasani, Hamidreza MD; Silbert, David MD, FAAP

doi: 10.1097/ICO.0b013e3182a48028
Clinical Science

Purpose: To determine the effect of retained donor Descemet membrane (DMs) on visual outcomes, contrast sensitivity (CS), higher-order aberrations (HOAs), and central graft thickness after deep anterior lamellar keratoplasty (DALK) using the big-bubble technique.

Methods: In this retrospective comparative study, keratoconic eyes undergoing a DALK using the big-bubble technique were enrolled. A bared DM was achieved in all cases. A donor cornea without (group 1; 48 eyes) or with (group 2; 22 eyes) DM was sutured to the recipient bed. The 2 groups were compared in terms of best spectacle-corrected visual acuity, keratometric astigmatism, refractive error, CS, HOAs, and central graft thickness at least 3 months after complete suture removal. Additionally, the rate of postoperative pseudoanterior chamber formation was compared between the study groups.

Results: The mean follow-up duration was 23.2 ± 6.9 months in group 1 and 26.5 ± 6.5 months in group 2 (P = 0.61). The postoperative best spectacle-corrected visual acuity was 0.18 ± 0.08 logMAR and 0.24 ± 0.30 logMAR, respectively (P = 0.36). The 2 groups had comparable postoperative keratometric astigmatism, spherical equivalent refraction, and HOAs. In terms of CS, however, group 1 demonstrated better results at a low spatial frequency. The mean postoperative central graft thickness was greater in group 2 (589.8 ± 34.5 μm) than in group 1 (523.6 ± 63.0 μm; P < 0.001). A pseudoanterior chamber developed in 3 eyes of group 1 and in 2 eyes of group 2 (P = 0.23). All cases were successfully managed by giving an intracameral air injection.

Conclusions: DALK performed using the big-bubble technique for keratoconus may give better results in terms of CS if a donor cornea without DM is transplanted.

*Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Labbafinejad Medical Center, Tehran, Iran; and

Family Eye Group, Lancaster, PA.

Reprints: Sepehr Feizi, Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Labbafinejad Medical Center, Boostan 9 St, Pasdaran Ave, Tehran 16666, Iran (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received April 04, 2013

Accepted July 10, 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.