Abstract
The present study's aim was to compare the biomechanical properties of corneal tissue in patients who underwent deep anterior lamellar keratoplasty (DALK) surgery, with successful big bubble formation and manual lamellar dissection, during failed big bubble formation. This retrospective comparative study included 60 eyes from 60 keratoconus patients who previously underwent DALK surgery. These patients were categorized as big bubble (+) or big bubble (-) based on the success or failure of big bubble formation during the surgery. The big bubble (+) group included 42 eyes, while the big bubble (-) group had 18 eyes. Moreover, the patients were regrouped as 0.25 mm and 0.50 mm to evaluate the effects of the disparity between donor and trephine punches on the biomechanical properties of the cornea. These biomechanical properties, characterized by corneal hysteresis and the corneal resistance factor, were measured using the Ocular Response Analyzer 12 months after the surgery. There was no statistically significant difference between the big bubble (+) and big bubble (-) groups in the biomechanical properties of the cornea (corneal hysteresis: 10.06, 10.25; p=0.716/corneal resistance factor: 10.15, 10.07; p=0.805, respectively). In addition, pachymetry results were not statistically different between the two groups. Multivariate regression analysis revealed that corneal hysteresis and corneal resistance factor were positively associated with central corneal thickness (p<0.001/r2=0.506; p<0.001/r2=0.561, respectively). However, the study did not demonstrate a relationship between any of the punch sizes and corneal hysteresis or between the punch sizes (p=0.673) and the corneal resistance factor (p=0.643). The corneal hysteresis and corneal resistance factor values were similar in big bubble and manual lamellar dissection after DALK. Thus, manual lamellar dissection was not a disadvantage considering the cornea's biomechanical properties.
Highlights
Keratoconus (KC) is a bilateral, non-inflammatory, and progressive ectatic disease of the cornea
Due to compli cations associated with penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK) has become the gold standard treatment for KC
We attempted to evaluate the effect of lamellar dissec tion due to unsuccessful BB formation on the cornea’s postoperative biomechanical properties, revealing no significant difference between the BB (+) and BB (−) groups
Summary
Keratoconus (KC) is a bilateral, non-inflammatory, and progressive ectatic disease of the cornea. Various approaches are used to treat KC. Treatment begins with spectacle correction of astigmatism, followed by use of rigid, gas-permeable contact lenses, collagen cross-linking, and intrastromal corneal ring segments. If these treatments do not provide acceptable vision, keratoplasty has been recommended[1]. Due to compli cations associated with penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK) has become the gold standard treatment for KC. DALK surgery has the advantage of preserving the host endothelium and reducing the risk of endothelial graft rejection[2]
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