Comparison of Descemet-On Versus Descemet-Off Deep Anterior Lamellar Keratoplasty in Keratoconus Patients: A Randomized Trial

• Published in: Cornea Vol. 34; no. 7; p. 797
• Main Authors: Prazeres, Tatiana M B, Muller, Rodrigo T, Rayes, Tatiana, Hirai, Flávio E, de Sousa, Luciene B
• Format: Journal Article
• Language: English
• Published: United States 01.07.2015
• Subjects: Adult; Cell Count; Contrast Sensitivity - physiology; Corneal Transplantation - methods; Descemet Membrane - surgery; Double-Blind Method; Endothelium, Corneal - pathology; Female; Humans; Keratoconus - physiopathology; Keratoconus - surgery; Male; Prospective Studies; Specimen Handling; Tissue Donors; Visual Acuity - physiology
• ISSN: 1536-4798
• DOI: 10.1097/ICO.0000000000000444

To compare the visual outcomes of Descemet membrane (DM)-on and DM-off after deep anterior lamellar keratoplasty (DALK) using the big-bubble (BB) technique in keratoconus patients. In this prospective trial, keratoconic eyes undergoing DALK procedures with the BB technique were randomized into 2 groups: a donor cornea without DM (group 1; 29 eyes) or with DM (group 2; 30 eyes). These groups were compared with respect to best-corrected visual acuity and contrast sensitivity while wearing gas permeable contact lenses and also endothelial cell counts. There were no statistically significant differences between the 2 groups with regard to best-corrected visual acuity and contrast sensitivity using gas permeable contact lenses as well as endothelial cell counts at 3, 6, and 12 months. After 1 year, the mean (±SD) postoperative visual acuity CL (with contact lenses) was 0.05 (±0.01) in the DM-off group and 0.05 (±0.01) in the DM-on group (P = 0.956). Mean postoperative endothelial cell counts were 2425.0 (±123.7) and 2306.7 (79.9), respectively (P = 0.443), and corneal thicknesses were 527.9 (58.3) and 556.6 (47.3), respectively (P = 0.150). During the follow-up period, very few complications occurred and neither group had a predominance of adverse events at 3, 6, 12, or 24 months. In conclusion, DALK procedures using the BB technique for keratoconus with DM-on or DM-off presented no significant differences regarding the visual outcomes or endothelial cell counts.