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Deep anterior lamellar keratoplasty in eyes previously treated with collagen crosslinking for keratoconus: 3-year results

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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.

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Acknowledgements

This study is the author’s own work. None of the authors has a financial or proprietary interest in any material or method mentioned. All the authors gave written permission to the corresponding author to be acknowledged.

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Authors and Affiliations

  1. Ophthalmology Department, Yeni Yuzyıl University Faculty of Medicine and Dunya Eye Hospital, Istanbul, Turkey

    Anıl Kubaloglu

  2. Ophthalmology Department, Faculty of Medicine, Bursa Uludag University, Görükle - Bursa, Turkey

    Esin Sogutlu Sari

  3. Ophthalmology Department, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey

    Arif Koytak

Authors
  1. Anıl Kubaloglu
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  2. Esin Sogutlu Sari
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  3. Arif Koytak
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Correspondence to Esin Sogutlu Sari.

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The study was in accordance with the ethical standards of the national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Kubaloglu, A., Sari, E.S. & Koytak, A. Deep anterior lamellar keratoplasty in eyes previously treated with collagen crosslinking for keratoconus: 3-year results. Graefes Arch Clin Exp Ophthalmol 258, 821–827 (2020). https://doi.org/10.1007/s00417-019-04587-6

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  • DOI: https://doi.org/10.1007/s00417-019-04587-6

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