Predictive factors for successful corneal dissection using the big bubble technique during deep anterior lamellar keratoplasty: an optic coherence tomography-based study

Session Details

Session Title: Cornea - Surgical III

Session Date/Time: Sunday 06/09/2015 | 14:15-16:15

Paper Time: 14:41

Venue: Room 16

First Author: : V.Borderie FRANCE

Co Author(s): :    S. Touhami   O. Sandali   L. Laroche              

Abstract Details

Purpose:

To analyse the predictive factors of a successful Big Bubble (BB) during Deep Anterior Lamellar Keratoplasty (DALK) using Optic Coherence Tomography (OCT).

Setting:

Clinical Investigation Center 503, French National Eye Hospital, Paris, France

Methods:

Retrospective review of all patients who underwent DALK by the same experienced surgeon (VB) between 2003 and 2014 at the Quinze-Vingts Hospital, Paris. For each patient, clinical and when available OCT data was collected preoperatively: corneal disease, best corrected visual acuity (BCVA), central and minimal corneal thicknesses (CT), difference between maximal and minimal (∂1) and median and minimal (∂2) CT, Sandali's OCT classification (SOC) when the pathology was keratoconus (KC) and presence of stromal scars on OCT; and perioperatively: diameter and depth of trephination. All variables were correlated to the occurrence of a successful BB.

Results:

236 patients underwent DALK during the study period: 72.5% for KC, 8.5% for corneal dystrophies, 9.7% for Herpes and 9.3% for corneal scars. Median age was 33 years (13-83). Successful BB dissection was possible in 107 cases (45%). Among the 129 cases with manual dissection, perforation occurred in 25 cases (19%). The occurrence of a BB did not correlate with age, corneal disease, BCVA, central and minimal CT or trephination diameter. It was associated with: ∂1 CT>220um (p=0.017), ∂2 CT>110um (p=0.075), SOC stage 3 or 4 KC (p= 0.03), presence of scars in the posterior stroma (p=0.0005), and trephination depth (p=0.014).

Conclusions:

DALK has obvious advantages over penetrating keratoplasty at the cost of a steep learning curve that the BB technique has made easier to overcome. However, BB aspect is not constant even for experienced surgeons and manual dissection with a risk of perforation is often necessary when the BB fails. This study showed for the first time the value of easily available preoperative OCT parameters to predict the success of a BB and DALK outcome, which can help with the surgical decision and avoid complications especially during the procedure learning phase.

Financial Interest:

NONE