Double Bubble Technique For Deep Anterior Lamellar Keratoplasty: Results In 53 Cases

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Double Bubble Technique For Deep Anterior
Lamellar Keratoplasty Results In 53 Cases

• Sagar Kharosekar MS
• Ajay K MS, Chetan A MS
• Suchi Smita MS, Sri Ganesh MS

The authors have no financial interest
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We have no financial interest

• Purpose
• To present our experience with
• double bubble technique
• of deep lamellar keratoplasty (DALK)
• for various conditions. 

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Methods

• Retrospective analysis of refractive outcome of
  53 DALK cases
• Comparison of Pre and post SR (suture removal)
  BCVA
• Incidence of
• DM detachment
• Uretts Zavalia Syndrome Rejection
• Infection
• IOP rise
• Graft dehiscence

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Methods

• 46 keratoconus
• 13 with post hydrops scars
• 1 post LASIK ectasia
• 3 central scars sec to interstitial keratitis
• 2 PMCD
• 1 severe GDLD
• Minimum follow up 1 yr

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Results

• Preop BCVA 4.47/60 (CFCF - 6/24)
• DALK done in 48 (90.57) eyes
• 5 converted to PK
• Intraop DM microperforations in 5 eyes,
• but DALK completed successfully
• Of these, 4 eyes required intracameral C3F8
• 2 with central perforations took 15 and 19 wks
  respectively for graft edema to recover
• Both doing well ( BCVA 6/12, N8 6/18, N6
  respectively)

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Results

• Postop Uretts Zavalia Syndrome 12 eyes
• None recovered
• Raised IOP 2 eyes, managed medically
• Graft infection 4 eyes,
• All bacterial, 3 GPC, 1 GNB
• One in previous HSV scar
• All recovered

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Results

• 3 eyes required repeat keratoplasty
• One each for
• Graft infection (PK) (BCVA 6/12,N6P)
• Graft dehiscence (Repeat DLK)(6/24,N8)
• Post suture removal (SR) DM detachment
  (PK)(6/9,N6)
• All doing well

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Results

• SR completed by 20.1 wks(3-52 wks)
• Post SR final average BCVA
• 44 eyes 6/15 (CF 0.5m - 6/6)
• 22 eyes 6/12
• Cylinder Average - 1.43 (0 to 2.75 D)
  
• No episodes of rejection

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Conclusion

• Double bubble method ( air in AC big bubble)
  worked well in our cases
• Visual outcome was good
• Urrets Zavalia syndrome was more frequent in our
  series, probably due to air in AC
• Cases of post SR DM detachment graft dehiscence
  warrant more precaution during SR.

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• Thank you