الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Purpose: To evaluate the visual and refractive outcomes after deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in eyes with keratoconus.
Methods: In this study 20 eyes with moderate to advanced keratoconus underwent DALK. All of them had poor spectacle-corrected visual acuity or were contact lens intolerant. DALK was performed using the big-bubble technique. Full thickness donor cornea without Descemet’s membrane (DM) was sutured to the recipient bed with two different suturing techniques. The visual acuity refractive status, intraoperative and postoperative complications were evaluated.
Results: Of 27 cases in which DALK using big bubble technique was attempted, Big-bubble was achieved successfully in 22 cases, in 2 eyes (9%), the procedure was converted to PKP because of Descemet’s membrane macroperforations, with big bubble success (74%). Therefore, data for 20 eyes (9 males) were included for analysis. The mean age of at the time of surgery was 21.75 years ± 5.025 years. The mean preoperative log MAR was 1.306 ±0.3500 that changed to 0.739± 0.1324, 0.3975 ±0.1455, 0.2965 ±0.1477 and 0.225±0.133 after 1, 3, 6 and 12 months respectively. DM perforation microperforations occurred in 2 eyes. One patient developed stromal rejection
Conclusions: DALK using the big-bubble technique appears to be a safe and effective procedure for eyes with moderate to advanced keratoconus. Without the risk of endothelial rejection. In case of extensive intraoperative DM perforation, it does not pose any limitation to ongoing penetrating keratoplasty.
Key Words: keratoconus, deep anterior lamellar keratoplasty, big bubble
technique, visual outcomes.