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Outcomes of big-bubble deep anterior lamellar keratoplasty for pediatric keratoconus

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Abstract

Purpose

To evaluate the outcomes and complications of deep anterior lamellar keratoplasty (DALK) performed for pediatric keratoconus.

Methods

This retrospective study enrolled 44 consecutive eyes of 39 keratoconus-affected children (≤ 18 years of age). All patients underwent big-bubble DALK from March 2004 to June 2016. The outcome measures included postoperative best spectacle-corrected visual acuity (BSCVA), manifest refraction, keratometry readings, and complications.

Results

The mean participant age was 16.8 ± 1.4 years, and the mean follow-up period was 68.5 ± 39.9 months. Successful big bubble was achieved in 33 eyes (75.0%), while the surgical technique was predescemetic DALK in 11 (25.0%). The mean BSCVA changed from 1.34 ± 0.49 LogMAR preoperatively to 0.24 ± 0.10 LogMAR postoperatively (P < 0.001). The mean keratometry decreased from 59.54 ± 5.17 D preoperatively to 46.23 ± 2.17 D postoperatively (P < 0.001). The complications encountered during the study period were intraoperative Descemet’s membrane perforation (n = 5, 11.4%), the Urrets Zavalia syndrome (n = 1, 2.3%), graft epithelial problems (n = 3, 6.8%), subepithelial graft rejection (n = 5, 11.4%), high intraocular pressure (n = 8, 18.2%), and traumatic wound dehiscence (n = 2, 4.6%). Suture-related complications included premature loosening (n = 13, 29.6%), broken sutures (n = 12, 27.3%), suture-tract vascularization (n = 6, 13.6%), suture-associated abscesses (n = 5, 11.4%), and suture cheese wiring (n = 2, 4.6%). A clear graft was found in 40 eyes (90.9%) at the last follow-up examination.

Conclusion

This study showed promising results with big-bubble DALK in keratoconus-affected children. A frequent and close follow-up with dedicated parental involvement is essential for the early recognition and management of postoperative complications.

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Authors and Affiliations

  1. Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Boostan 9 St, Pasdaran Avenue, Tehran, 16666, Iran

    Sepehr Feizi, Mohammad Ali Javadi, Maryam Najafi, Mohammad Abolhosseini & Seyed-Mohamadmehdi Moshtaghion

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  1. Sepehr Feizi
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  2. Mohammad Ali Javadi
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  3. Maryam Najafi
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  4. Mohammad Abolhosseini
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  5. Seyed-Mohamadmehdi Moshtaghion
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Correspondence to Sepehr Feizi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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An informed consent was obtained from the parents or legally authorized representatives of minors who participated in this study.

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Feizi, S., Javadi, M.A., Najafi, M. et al. Outcomes of big-bubble deep anterior lamellar keratoplasty for pediatric keratoconus. Int Ophthalmol 40, 1253–1259 (2020). https://doi.org/10.1007/s10792-020-01291-x

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  • DOI: https://doi.org/10.1007/s10792-020-01291-x

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