Big-bubble deep anterior lamellar keratoplasty for post-keratitis and post-traumatic corneal stromal scars

Background: Evaluation of outcomes of big-bubble deep anterior lamellar keratoplasty in cases with post-keratitis and post-traumatic corneal scars. Design: Interventional case series. Participants: Patients with corneal stromal scarring secondary to healed infectious keratitis or trauma were recruited from the Corneal Clinic of the M. M. Joshi Eye Institute, Karnataka, India between August 2007 and December 2009. Methods: All patients underwent big-bubble deep anterior lamellar keratoplasty surgery. Main Outcome Measures: Best-corrected visual acuity, as well as intra- and postoperative complications. Results: Big-bubble deep anterior lamellar keratoplasty was performed in 36 patients (25 males, 11 females) with post-infectious keratitis (n=22) and post-traumatic (n=14) corneal stromal scars sparing the Descemet's membrane and endothelium. Mean age was 39.7±11.3years (range: 22-58 years). Although a big bubble was achieved in all eyes (100%), intraoperative perforation of the Descemet's membrane occurred in six eyes (16%) during stromal dissection. Two cases required conversion to penetrating keratoplasty. A double anterior chamber occurred in the immediate postoperative period in three cases (8.3%). Raised intraocular pressure was seen in one eye. Mean preoperative best-corrected visual acuity (0.03±0.04) improved significantly at the end of 6months follow-up postoperatively (0.43±0.20; P<0.01, Wilcoxon signed-ranks test). Corneal stromal graft rejection was noted in two cases (5.5%) during the first 3months after surgery. Graft failure occurred in two cases (5.5%). Conclusions: Deep anterior lamellar keratoplasty using the big-bubble technique is a viable option in cases with post-infectious keratitis and post-traumatic corneal stromal scarring with normal Descemet's membrane and endothelium.