June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Predictive factors for successful corneal dissection using the big bubble technique during deep anterior lamellar keratoplasty: An Optic Coherence Tomography-based Study
Author Affiliations & Notes
  • Sara Touhami
    CHNO des Quinze-Vingts, Paris, France
    Ophthalmology, Pitié Salpétrière Hospital, Paris, France
  • Otman Sandali
    CHNO des Quinze-Vingts, Paris, France
  • Laurent Laroche
    CHNO des Quinze-Vingts, Paris, France
  • Vincent M Borderie
    CHNO des Quinze-Vingts, Paris, France
  • Footnotes
    Commercial Relationships Sara Touhami, None; Otman Sandali, None; Laurent Laroche, None; Vincent Borderie, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 3973. doi:
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      Sara Touhami, Otman Sandali, Laurent Laroche, Vincent M Borderie; Predictive factors for successful corneal dissection using the big bubble technique during deep anterior lamellar keratoplasty: An Optic Coherence Tomography-based Study. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3973.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: To analyse the predictive factors of a successful Type1-Big Bubble (T1BB) during deep anterior lamellar keratoplasty (DALK) using Optic Coherence Tomography (OCT).

Methods: Prospective observational study of all patients undergoing DALK by the same experienced surgeon (VB) between January 2003 and June 2014 at the Quinze-Vingts Hospital, Paris. For each patient, clinical and 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 disease 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 T1BB as described by Anwar and Dua using T-student, Fisher exact and Bonferonni post-hoc tests.

Results: 236 patients underwent DALK during the study period: 72,5% for KC (n=171), 8,5% for corneal dystrophies (n=20), 9,7% for Herpes (n=23) and 9,3% for corneal scars related to other diseases (n=22). Median age was 33 years (Range:13-83). Successful T1BB dissection was possible for 107 patients (45%). Among the 55% patients for whom dissection was completed manually, perforation occurred in 19% of the cases (n=25). OCT data was analysed for the 56 patients who benefited from OCT using the same Optovue RTvue® device. The occurrence of a T1BB was not correlated to age, corneal disease, BCVA, central and minimal CT or trephination diameter. It seemed correlated to a ∂1 CT>220um (p=0.017) a ∂2 CT>110um (p=0.075}, a stage 3 or 4 KC based on SOC (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, which the BB technique has facilitated. However, T1BB 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 T1BB and DALK outcome, which can help with the surgical decision and avoid complications especially during the learning phase.

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