Deep anterior lamellar keratoplasty in eyes previously treated with collagen crosslinking for keratoconus: 3-year result
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Deep anterior lamellar keratoplasty in eyes previously treated with collagen crosslinking for keratoconus: 3-year results Anıl Kubaloglu 1 & Esin Sogutlu Sari 2 & Arif Koytak 3 Received: 20 August 2019 / Revised: 29 November 2019 / Accepted: 19 December 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To evaluate the 3-year results of deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in keratoconus patients with previous corneal collagen crosslinking (CXL) treatment. Methods Twenty eyes of 20 keratoconus patients who underwent DALK surgery using the big-bubble technique after CXL treatment between January 2011 and September 2015 were retrospectively reviewed. All patients completed 3 years follow-up. Intraoperative and postoperative complications were recorded. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), maximum keratometry, keratometric astigmatism and endothelial cell density (ECD) were analysed. Results The mean interval between CXL and DALK surgery was 47.5 ± 24.0 months (mean ± SD). DALK was completed in all eyes. Big-bubble was successfully achieved in 16 eyes (80%), and manual dissection was performed in four eyes (20%). Microperforation occurred in three eyes (15%). Postoperatively, persistent epithelial defect occurred in three eyes (15%). The mean UCVA and mean BSCVA values were significantly improved preoperatively to all postoperative visits (p < 0.001). UCVA was 20/100 or lower in all eyes preoperatively and 20/100 or better in 18 eyes (80%) at 3 years; BSCVA was 20/40 or better in all eyes (100%) and 20/20 or better in three eyes (15%), and keratometric astigmatism was lower than 4 dioptres in 14 eyes (70%) at 3 years. The mean ECD loss was 6.3 ± 4.4% at 1 year, 9.0 ± 6.3% at 2 years and 11.2 ± 7.4% at 3 years. Conclusion Previous CXL treatment in keratoconus patients did not cause a negative impact on the visual, refractive and surgical outcomes of DALK surgery using the big-bubble technique. DALK surgery seems to be a safe and effective surgical approach in these patients. Keywords Keratoconus . Corneal collagen crosslinking . Deep anterior lamellar keratoplasty
Introduction The management of keratoconus is focused on two main targets: (1) improvement of visual function via spectacles, contact lenses, intracorneal ring segments (ICRS) and corneal transplantation; and (2) the prevention of disease progression by corneal collagen crosslinking (CXL) [1]. The therapeutic
* Esin Sogutlu Sari [email protected] 1
Ophthalmology Department, Yeni Yuzyıl University Faculty of Medicine and Dunya Eye Hospital, Istanbul, Turkey
2
Ophthalmology Department, Faculty of Medicine, Bursa Uludag University, Görükle - Bursa, Turkey
3
Ophthalmology Department, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
effect of CXL is based on additional chemical bonds in corneal stroma through the photo-polymerisation of collagen fibres with the interaction of riboflavin and ultraviolet A, which c
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