Abstract
PURPOSE: To determine the variations in deep anterior lamellar keratoplasty (DALK) techniques in eyes with macular corneal dystrophy (MCD), and to compare visual outcomes between standard DALK and Descemet's membrane (DM) baring DALK. METHODS: A retrospective comparative case series was conducted, categorizing eyes into two groups: Group A, without DM baring, and Group B, with central DM baring. All DALK surgeries for MCD conducted between January 2010 and August 2020 at our institution were included in this study. RESULTS: The study comprised 29 eyes from 18 patients with a mean follow-up period of 54.85 months. Type 1 bubble was achieved in 4 eyes (13.8%), type 2 or mixed bubbles were formed in 19 eyes (65.5%), and failed big bubble formation occurred in 6 eyes (20.7%). Group A (non-DM baring) comprised 18 eyes (62.1%), while Group B (central DM baring) included 11 eyes (37.9%). No statistically significant differences were found between the groups in terms of best-corrected visual acuity, spherical equivalent, or topographic astigmatism. However, Group B demonstrated significantly improved contrast sensitivity (P < 0.01). Group A displayed persistent or recurrent MCD opacities in 11 eyes (73.3%), whereas none were observed in Group B, demonstrating a statistically significant difference (P < 0.001). CONCLUSIONS: The incidence of type 2 or mixed bubbles in MCD cases is relatively high, facilitating central DM baring. In this series, central DM baring correlated with improved contrast sensitivity and prevented MCD opacities recurrence. Thus, it should be considered in all DALK cases for MCD if a type 2 bubble is formed.