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REVIEW  MODERN TECHNIQUES OF LAMELLAR KERATOPLASTY 

Minerva Oftalmologica 2018 December;60(4):183-95

DOI: 10.23736/S0026-4903.18.01815-9

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Big-bubble deep anterior lamellar keratoplasty

Giuseppe GIANNACCARE

Unit of Ophthalmology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy



The adoption of deep anterior lamellar transplantation (DALK) represents a fundamental step forward in cornea surgery. Nowadays, DALK has replaced penetrating keratoplasty (PK) for the treatment of disorders affecting the corneal stromal layers. When DALK is performed according to the big bubble (BB) technique, after a partial-thickness corneal trephination, a needle is inserted, deeply and bevel down into the paracentral corneal stroma and air is injected in order to form a large air bubble baring the Descemet’s membrane. Anterior lamellar keratectomy is performed, then a small opening is made in the top of the air bubble and the remaining stromal layers are lifted. The main advantages of DALK over PK is the avoidance of endothelial immunological rejection, that represents the main cause of PK failure, as well as the intraoperative safety due to the reduced opening of the eye. Despite these advantages the number of DALK procedures performed each year remains low. The most reasonable explanations are its technical difficulty, characterized by a steep learning curve and a long surgical time, and the risk of rupture of Descemet’s membrane that may require the conversion to PK. Since visual and refractive outcomes do not differ substantially between DALK and PK, the benefits of the former outweigh the risk of possible additional complications. Thus, DALK should be performed for each stromal disease with normal endothelial cell count.


KEY WORDS: Corneal transplantation - Descemet stripping endothelial keratoplasty - Surgery

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