Visual outcomes after deep anterior lamellar keratoplasty using donor corneas without removal of Descemet membrane and endothelium

ABSTRACT Purpose: The optical quality of the interface after deep anterior lamellar keratoplasty (DALK) using the big-bubble technique has been shown to be excellent, leading to results comparable to penetrating keratoplasty. However, there is little in the literature with respect to the controversy surrounding the preparation of the donor cornea. The purpose of this study was to evaluate visual acuity (VA) in patients with keratoconus who underwent DALK without removal of the donor graft endothelium. Methods: The records of 90 patients who underwent DALK without the removal of the Descemet membrane (DM) and endothelium were retrospectively reviewed. Data collected included uncorrected VA (UCVA) and spectacle-corrected VA (SCVA) at 7, 30, 180 days, and 1 year postoperatively. Contact lens-corrected visual acuity (CLVA) was evaluated after 1 year of the procedure. Results: UCVA was significantly better than preoperative values at 7 days (p<0.001), 30 days (p<0.001), 180 days (p<0.001), and 1 year (p<0.001) after surgery. The 1-year postoperative mean SCVA and CLVA also improved when compared with preoperative SCVA (p<0.001 for both). Conclusions: DALK utilizing donor corneas with attached Descemet membrane and endothelium results in satisfactory VA in patients with keratoconus.