Deep Anterior Lamellar Keratoplasty Using the Big-Bubble Technique in Keratoconus.

Purpose: to evaluate the visual outcomes and complications of deep anterior lamellar keratoplasty (dalk) using the big-bubble technique in patients with keratoconus. methods: in this case series, 104 eyes of 99 patients with moderate to advanced keratoconus underwent dalk. all subjects were contact lens intolerant or had unacceptable spectacle-corrected visual acuity. dalk was performed using the big-bubble technique. full thickness donor corneas devoid of descemet's membrane (dm) were sutured to the recipient bed. best spectacle-corrected visual acuity (bscva), refractive status, and intra- and postoperative complications were evaluated. results: patients were male in 62.5%. mean age of patients was 26.2±7.79 (range 15-46) years at the time of dalk and were followed for 23.07±8.1 (range 9-42) months. mean bscva increased from 1.23±0.4 logmar to 0.26±0.2 logmar at final follow-up (p < 0.001). postoperative mean spherical equivalent refractive error and refractive and keratometric astigmatism were -3.41±3.1 d, 3.07±2.4 d, and 3.64±2.2 d, respectively. bared dm was achieved in 86 (82.7%) eyes. main complications encountered included filamentary keratitis (19.2%), non-endothelial graft rejection (14.4%), and suture abscess (10.6%). conclusions: dalk using the big-bubble technique appears to be a safe and effective procedure in patients with keratoconus.