Double Bubble Technique For Deep Anterior Lamellar Keratoplasty:

Results In 53 CasesSagar Kharosekar MS

Ajay K MS, Chetan A MSSuchi Smita MS, Sri Ganesh MS

The authors have no financial interest

We have no financial interest

• PurposeTo present our experience with

double bubble technique of deep lamellar keratoplasty (DALK) for various conditions.

Methods• Retrospective analysis of refractive outcome of 53

DALK cases • Comparison of Pre and post SR (suture removal) BCVA • Incidence of

DM detachmentUretts Zavalia Syndrome RejectionInfectionIOP riseGraft dehiscence

Methods

• 46 keratoconus13 with post hydrops scars

• 1 post LASIK ectasia• 3 central scars sec to interstitial keratitis• 2 PMCD • 1 severe GDLD• Minimum follow up : 1 yr

Results• Preop BCVA : 4.47/60 (CFCF - 6/24)• DALK done in 48 (90.57%) eyes• 5 converted to PK• Intraop DM microperforations in 5 eyes,

but DALK completed successfully• Of these, 4 eyes required intracameral C3F8

2 with central perforations took 15 and 19 wks respectively for graft edema to recoverBoth doing well ( BCVA 6/12, N8 & 6/18+,

N6 respectively)

Results• Postop Uretts Zavalia Syndrome : 12 eyes

None recovered• Raised IOP: 2 eyes, managed medically• Graft infection: 4 eyes,

All bacterial, 3 GPC, 1 GNBOne in previous HSV scarAll recovered

Results

• 3 eyes required repeat keratoplastyOne each for Graft infection (PK) (BCVA 6/12,N6P)Graft dehiscence (Repeat DLK)(6/24,N8)Post suture removal (SR) DM detachment (PK)(6/9,N6)

• All doing well

Results

• SR completed by 20.1 wks(3-52 wks)• Post SR final average BCVA • 44 eyes: 6/15 (CF 0.5m - 6/6)• 22 eyes: ≥ 6/12• Cylinder: Average: - 1.43 (0 to – 2.75 D) • No episodes of rejection

Conclusion

• Double bubble method ( air in AC & big bubble) worked well in our cases

• Visual outcome was good• Urrets Zavalia syndrome was more frequent in

our series, probably due to air in AC• Cases of post SR DM detachment & graft

dehiscence warrant more precaution during SR.

Thank you