Título

PHACOEMULSIFICATION WITH THE BIG-BUBBLE DALK TECHNIQUE: NEW TRIPLE PROCEDURE

Objetivo

Patients with combined advanced ectasias and cataracts represent surgical challenges, of which there are several approaches. Some authors suggested a triple procedure using a Big- Bubble DALK technique first and after, phacoemulsification. We performed a variant of these triple procedures. First, we performed phacoemulsification and then, a corneal graft using the Big- Bubble DALK technique.

Método

We performing this new technique in 5 pacientes.After phacoemulsification, lamellar graft procedure was performed with partial-thickness trephination of the cornea and intrastromal injection of air that separated the cornea into two layers, constituting the anterior wall of the BB-DALK of corneal stroma and the posterior part of Descemet membrane(DM )and endothelium. This anterior part was partially removed with a crescent blade. The remaining stroma was punctured and opened to deflate the big bubble. After putting the viscoelastic inside the space formed by the big bubble, a round spatula was inserted into this space to relieve peripheral adherences between DM and the stroma. Then, all stroma was removed, leaving only the DM and the endothelium.A Donor corneal button from which the DM and endothelium were removed was placed over the DM-bearing receptor. The corneal graft was sutured in place with 16 interrupted 10/0 nylon sutures.

Resultado

All keratoconus cases were advanced and central, with a mean apical curvature of 68.7 diopters (range, 59.3–73.8) on topography maps and a mean central corneal thickness of 425 microns (range, 373–458). After a mean follow-up of approximately two years, our cases showed clinically acceptable residual ametropia, with a mean spherical equivalent of -2.0 ± 0.9 DP (standard error) (range = -3.75 to +0.5).The mean BCVA was 1.5 ± 0.20 logMAR before surgery and 0.27 ± 0.04 logMAR after surgery (P = 0.0045; paired t-test).

Conclusão

Patients with advanced ectasias and cataracts, we recommend performing a triple procedure: phacoemulsification first and then corneal graft using the BB-DALK technique.